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Related Experiment Videos

Coronary sinus electrode does not reduce atrial defibrillation thresholds.

Eric J Rashba1, Stephen R Shorofsky, Avram Scheiner

  • 1Division of Cardiology, University of Maryland School of Medicine, Baltimore, 21201, USA. erashba@medicine.umaryland.edu

Heart Rhythm
|May 30, 2006
PubMed
Summary
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Adding a coronary sinus (CS) electrode to implantable cardioverter-defibrillator (ICD) systems does not improve atrial defibrillation thresholds (DFTs). The conventional ventricular triad configuration remains reliable for both atrial and ventricular defibrillation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Atrial defibrillation is achievable with standard dual-coil implantable cardioverter-defibrillator (ICD) systems.
  • The use of coronary sinus (CS) electrodes for alternative shocking vectors is explored, but their efficacy in improving atrial defibrillation thresholds (DFTs) is uncertain.

Purpose of the Study:

  • To prospectively evaluate whether incorporating a CS electrode enhances atrial defibrillation efficacy in patients receiving an ICD.
  • To compare the atrial defibrillation thresholds (DFTs) using different shocking configurations.

Main Methods:

  • A prospective, randomized study involving 36 patients undergoing initial ICD implantation.
  • Three shocking configurations were tested: Ventricular Triad (RV-SVC+Can), Distal Atrial Triad (CS-SVC+Can), and Proximal Atrial Triad (CS-SVC+Can).

Related Experiment Videos

  • Atrial DFTs were measured for each configuration, with the order of testing randomized.

    • Main Results:

    • While Proximal and Distal Atrial Triad configurations reduced peak current, increased shock impedance negated this benefit.
    • No significant difference in peak voltage or DFT energy was observed compared to the Ventricular Triad.
    • Ventricular Triad: 4.9 ± 6.6 J, Proximal Atrial Triad: 3.3 ± 4.1 J, Distal Atrial Triad: 4.4 ± 6.7 J (p > 0.2).

    Conclusions:

    • Coronary sinus (CS) coil incorporation does not significantly improve atrial defibrillation efficacy.
    • The conventional Ventricular Triad configuration offers reliable atrial and ventricular defibrillation.
    • The Ventricular Triad is recommended for combined atrial and ventricular ICDs.