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Comparison of defibrillation thresholds using monodirectional electrical vector versus bidirectional electrical

L Libero1, I F Lozano, M Bocchiardo

  • 1Cardiology Department, University of Turin, Italy. luigi.libero@galactica.it

Italian Heart Journal : Official Journal of the Italian Federation of Cardiology
|July 17, 2001
PubMed
Summary
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The bidirectional electrical vector configuration for implantable cardioverter-defibrillators (ICD) significantly lowers the defibrillation threshold (DFT) compared to the monodirectional configuration. This study found no impact of repeated shocks on the final DFT, confirming the bidirectional approach

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Devices

Background:

  • Current implantable cardioverter-defibrillator (ICD) lead configurations include monodirectional (hot can + RV coil) and bidirectional (TRIAD) systems.
  • The TRIAD system adds a proximal defibrillation electrode for a bidirectional electrical vector.

Purpose of the Study:

  • To compare the acute defibrillation threshold (DFT) between bidirectional (TRIAD) and monodirectional (hot can) ICD lead configurations.
  • To assess the effect of sequential arrhythmia induction and defibrillation shocks on the final DFT.

Main Methods:

  • A prospective study involving 44 patients undergoing ICD implantation.
  • Dual DFT testing (bidirectional vs. monodirectional) was performed using a step-down to failure protocol.
  • Randomization determined the initial configuration tested.

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Main Results:

  • The average DFT was significantly lower for the TRIAD bidirectional configuration (8.6 J) compared to the monodirectional configuration (10.4 J) (p=0.009).
  • This represents a 16.3% reduction in DFT with the bidirectional configuration.
  • No correlation was found between the final DFT and the number of ventricular fibrillation inductions or shocks received.

Conclusions:

  • The bidirectional electrical vector configuration offers a clear advantage by reducing the DFT.
  • This suggests improved patient benefit with the TRIAD system compared to traditional monodirectional configurations.