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"Tuned" defibrillation waveforms outperform 50/50% tilt defibrillation waveforms: a randomized multi-center study.

Senthil Natarajan1, Richard Henthorn, Jefferson Burroughs

  • 1Rochester General Hospital, Rochester, New York, USA. senthil-natarajan@hotmail.com

Pacing and Clinical Electrophysiology : PACE
|February 17, 2007
PubMed
Summary
This summary is machine-generated.

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A new tuned waveform for implantable cardioverter defibrillators significantly lowers defibrillation thresholds (DFTs) compared to standard 50% tilt waveforms. This optimized waveform reduces energy and voltage requirements, especially in patients with low ejection fraction.

Area of Science:

  • Cardiovascular Electrophysiology
  • Medical Device Technology

Background:

  • Previous studies demonstrated superior performance of tuned waveforms over standard 65/65% tilt waveforms.
  • Direct comparison between tuned and 50/50% tilt waveforms was lacking.

Purpose of the Study:

  • To directly compare the defibrillation thresholds (DFTs) of tuned waveforms against standard 50/50% tilt waveforms.
  • To evaluate the impact of waveform selection on energy and voltage requirements for defibrillation.

Main Methods:

  • 34 patients underwent DFT measurements using both tuned and 50/50% tilt waveforms in a randomized order.
  • Optimized binary search method was employed for DFT determination.
  • High voltage lead impedance was measured to optimize pulse widths for each waveform type.

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Main Results:

  • The tuned waveform resulted in significantly lower delivered energy (7.3 vs 8.7 J) and stored energy (8.2 vs 9.7 J) compared to the 50/50% tilt waveform (P=0.01).
  • Delivered voltage was also significantly lower with the tuned waveform (405.9 vs 445.0 V, P=0.008).
  • In patients with high DFTs, the tuned waveform reduced mean energy DFT by 2.8 J and mean voltage DFT by 45 V, representing a 24% decrease in peak delivered energy DFT.

Conclusions:

  • Implantable cardioverter defibrillators utilizing a tuned waveform demonstrate lower energy and voltage defibrillation thresholds compared to those using a standard 50% tilt biphasic waveform.
  • A left ventricular ejection fraction below 20% was identified as a significant predictor of the advantage offered by the tuned waveform.