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Related Experiment Videos

Experience with a third-generation implantable cardioverter-defibrillator.

S Saksena1, D Mehta, R B Krol

  • 1Eastern Heart Institute, General Hospital Center, Passaic, New Jersey 07055.

The American Journal of Cardiology
|June 15, 1991
PubMed
Summary

This study shows that a hybrid pacemaker cardioverter-defibrillator effectively treats ventricular tachycardia and fibrillation. Pacing therapies combined with shocks offer a safe and reliable treatment option for patients with heart disease.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Patients with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and organic heart disease often have reduced left ventricular ejection fraction.
  • Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias.
  • Evaluating the efficacy of different defibrillation strategies and pacing therapies is essential for optimizing patient outcomes.

Purpose of the Study:

  • To assess the feasibility and efficacy of individualized electrical therapy using a Medtronic 7216A pacemaker cardioverter-defibrillator in patients with VT/VF.
  • To evaluate defibrillation shock efficacy with various electrode configurations and shock patterns.
  • To determine the effectiveness of pacing and shock therapies for terminating induced and spontaneous VT/VF episodes.

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Main Methods:

  • Implantation of a Medtronic 7216A pacemaker cardioverter-defibrillator in 16 patients with VT/VF and organic heart disease.
  • Evaluation of endocardial and epicardial defibrillation shock efficacy using monophasic shocks (single, sequential, simultaneous) with dual and triple electrode configurations.
  • Assessment of VT/VF detection rates and termination efficacy using pacing, shock therapy, or both.
  • Noninvasive induction of VT/VF post-implant for testing therapeutic responses.

Main Results:

  • Epicardial defibrillation thresholds ranged from 3 to 18 J, with no significant difference between sequential and simultaneous shocks.
  • VT detection rates were 340–470 ms, and VF detection rates were 270–330 ms.
  • All induced VF episodes were terminated by shocks; induced VT was terminated by pacing alone, low-energy shocks, high-energy shocks, or combined therapy.
  • During follow-up, 78% of spontaneous VT episodes were terminated by pacing, and all VT/VF episodes were successfully terminated by electrical therapy.

Conclusions:

  • Individualized electrical therapy using a programmable hybrid pacemaker cardioverter-defibrillator system is feasible and effective for patients with VT/VF.
  • Pacing therapies demonstrate efficacy for both induced and spontaneous VT termination, potentially reducing patient exposure to shocks.
  • The hybrid system offers nonthoracotomy implantation, effective arrhythmia termination, and versatile noninvasive troubleshooting capabilities.