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Bidirectional defibrillation using implantable defibrillators: a prospective randomized comparison between pectoral
B Sandstedt1, C Kennergren, N Edvardsson
1Division of Cardiology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden. bengt.sandstedt@swipnet.se
Pacing and Clinical Electrophysiology : PACE
|October 5, 2001
Summary
This study found no significant difference in defibrillation threshold (DFT) between abdominal and pectoral generator positions for bidirectional tripolar ICD systems. The pectoral site is preferred, but the abdominal position offers an alternative for high DFTs.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias.
- Optimizing generator placement is essential for effective defibrillation and patient outcomes.
- Bidirectional tripolar ICD systems offer advanced therapeutic capabilities.
Purpose of the Study:
- To compare the defibrillation threshold (DFT) of active abdominal versus pectoral generator positions in a bidirectional tripolar ICD system.
- To evaluate the efficacy of different generator placements for defibrillation energy requirements.
Main Methods:
- Twenty-five patients with newly implanted ICD systems underwent DFT testing.
- A randomized, step-down protocol was used with an active emulator in both abdominal and pectoral positions.
- Defibrillation energy and impedance were recorded for each position.
Main Results:
- No statistically significant difference was observed in mean DFT between abdominal (10.9 J) and pectoral (9.7 J) positions.
- Defibrillation energy was below 15 J in 72% (abdominal) and 88% (pectoral) of patients.
- Defibrillation impedance showed minimal difference between the two positions.
Conclusions:
- Generator position (abdominal vs. pectoral) does not significantly impact DFT in bidirectional tripolar ICD systems.
- The pectoral position is generally preferred, but the abdominal site serves as a viable alternative for patients with high DFTs.
- Further research is needed to assess long-term lead functionality differences between generator positions.