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Decline in defibrillation thresholds

M W Kroll1, K M Anderson, C G Supino

  • 1AngeMed, Plymouth, MN 55447.

Pacing and Clinical Electrophysiology : PACE
|January 1, 1993
PubMed
Summary
This summary is machine-generated.

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Defibrillation thresholds (DFT) have steadily declined over 18 years due to advancements in waveforms and electrodes. This meta-analysis reveals key factors influencing DFT reduction, impacting device development.

Area of Science:

  • Biomedical Engineering
  • Cardiology
  • Medical Device Technology

Background:

  • Research has focused on reducing defibrillation thresholds (DFT) through improved waveforms and electrodes.
  • It was hypothesized that DFTs are declining steadily, similar to pacing thresholds.

Purpose of the Study:

  • To conduct a meta-analysis of defibrillation thresholds (DFTs) from published reports.
  • To identify factors influencing the decline in DFTs over time.

Main Methods:

  • A meta-analysis of 105 reports on DFTs from 58 articles (1973-1991) was performed.
  • Included human, dog, and pig studies; excluded transthoracic and isolated heart studies.
  • Analyzed variables included publication year, study type, electrode type, waveform, and system configuration.

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Main Results:

  • DFTs showed a significant correlation with publication year (P = 0.013), dropping 0.75 joules/year.
  • Multivariate analysis (r2 = 0.51) identified six significant variables: epicardial electrodes, subcutaneous patch, biphasic wave, and coronary sinus electrode decreased DFTs; human subjects and catheter-based systems increased DFTs.

Conclusions:

  • Defibrillation thresholds have declined over 18 years due to electrode and waveform improvements.
  • The trend suggests a need to re-evaluate the practice of creating devices with ever-increasing energy ratings.
  • Animal models serve as useful predictors for clinical DFTs.