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Pericardial influence on internal defibrillation energy requirements
J H Lemmer1, L A Faber, D J Mariano
1Department of Surgery, University of Iowa College of Medicine, Iowa City, Iowa 52242.
Summary
Placing automatic implantable cardioverter defibrillator patch leads outside the pericardium does not affect defibrillation efficacy. This positioning simplifies implantation, even with thickened pericardium or adhesions.
Area of Science:
- Cardiovascular Surgery
- Electrophysiology
- Biomedical Engineering
Background:
- Optimal positioning of automatic implantable cardioverter defibrillator (AICD) patch leads remains debated.
- Pericardial adhesions may influence defibrillation energy requirements.
Purpose of the Study:
- To compare defibrillation energy requirements for AICD patch leads placed inside versus outside the pericardium.
- To evaluate the impact of thickened, adherent pericardium on defibrillation efficacy.
Main Methods:
- Open-chest dog model with titanium-mesh patch leads.
- Defibrillation testing performed with leads on epicardium and outside intact pericardium.
- Talc instillation to induce pericardial thickening and adhesions, followed by repeat testing.
Main Results:
- No significant difference in defibrillation energy for leads inside vs. outside intact pericardium.
- No significant difference in electrical impedance measurements.
- Thickened, adherent pericardium did not increase defibrillation energy requirements.
Conclusions:
- AICD patch lead placement outside the pericardium does not compromise defibrillation efficacy.
- Pericardial thickening and adhesions do not adversely affect defibrillation energy needs.
- External pericardial placement can simplify AICD implantation procedures.