Relationship between pacemaker fibrillation thresholds and electrode area

Energy thresholds for electrical pacing of the heart are lower with small electrodes than with large. Because pacing of the heart during the vulnerable period may produce ventricular fibrillation, it is also pertinent to know if fibrillation threshold is affected by the electrode size. Electrodes of different surface area but of the same material were implanted in 40 dogs and the pacing thresholds were recorded. Ventricular fibrillation was electrically induced by discharging a 2-msec d.c. cathodal pulse of progressively increasing energy into the vulnerable period. It was found that small electrodes required more energy to produce ventricular fibrillation than large electrodes, and the ratio of fibrillation to stimulation threshold was higher for the small-surface-area electrode. The difference between the thresholds and ratios obtained with the various electrodes was statistically significant. A similar experiment was performed in animals with chronically implanted electrodes, producing comparable results. The results indicate that, in regard to pacing and fibrillation thresholds, small electrodes are preferable to large.