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Low-energy defibrillation using a base-apex epicardial electrode.

Jun-Ichi Okada1,2, Takumi Washio1,2, Seiryo Sugiura1

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Summary

New sheet-shaped electrodes for implantable cardioverter defibrillators (ICDs) show potential for lower-energy defibrillation. Optimal electrode placement and shock delivery significantly reduce the defibrillation threshold (DFT).

Keywords:
computer simulationdefibrillationlow energysheet-shaped electrodesventricular fibrillation

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Area of Science:

  • Biomedical Engineering
  • Cardiovascular Devices
  • Electrophysiology

Background:

  • Current implantable cardioverter defibrillators (ICDs) use high-energy shocks that can harm cardiac function.
  • There is a need for ICDs that deliver effective defibrillation with lower energy to minimize risks.

Purpose of the Study:

  • To investigate sheet-shaped electrodes for epicardial application to reduce defibrillation threshold (DFT).
  • To identify optimal electrode configurations and shock parameters for low-energy defibrillation.

Main Methods:

  • Simulated heart models were used to test three electrode configurations (top-bottom, left-right, front-back).
  • Electrode clearance, shock waveform, direction, and insulator effects were analyzed to determine the lowest DFT.

Main Results:

  • An optimal electrode clearance was identified; too small or too large clearance increased DFT.
  • Top-bottom electrode configuration with optimal clearance and specific biphasic shock delivery yielded the lowest DFT.
  • Insulated electrodes reduced DFT by preventing unnecessary current loss.

Conclusions:

  • Sheet-shaped electrodes show promise for painless, low-energy defibrillation.
  • Optimized electrode design and shock delivery are crucial for effective ICD performance.