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Improved defibrillation threshold with a new epicardial carbon electrode compared with a standard epicardial titanium
E U Alt1, P C Fotuhi, R L Callihan
1Department of Medicine, Duke University Medical Center, Durham, NC.
Circulation
|January 15, 1995
Summary
A novel braided epicardial carbon electrode significantly reduces defibrillation energy needs compared to traditional titanium patches. This new system offers a more effective solution for patients requiring implantable defibrillators when nonthoracotomy systems are unsuitable.
Area of Science:
- Cardiovascular medicine
- Biomedical engineering
- Electrophysiology
Background:
- 5-15% of patients needing implantable defibrillators require epicardial systems due to shock morphology limitations.
- Standard epicardial titanium patches are currently used in these cases.
- A new epicardial carbon electrode is investigated as a potential alternative.
Purpose of the Study:
- To evaluate a newly developed braided epicardial carbon electrode.
- To compare its efficacy against a standard epicardial titanium patch.
- To determine its impact on defibrillation threshold energy and voltage requirements.
Main Methods:
- A tubular 7F, 14-cm braided carbon electrode was applied in a U-shape to the epicardium.
- It was tested against a 15-cm2 titanium mesh patch in eight dogs.
- Defibrillation threshold (DFT) was determined using two biphasic shock waveforms (3.2/2-ms and 6/6-ms) and various endocardial cathodes.
Main Results:
- The epicardial carbon electrode decreased mean DFT energy by 39-56% and voltage by 24-35% compared to the titanium patch.
- Significant reductions were observed with different cathode configurations and the 3.2/2-ms waveform.
- The 6/6-ms waveform showed a similar trend with slightly higher DFT values.
Conclusions:
- The braided epicardial carbon electrode offers a significant reduction in defibrillation energy requirements.
- Optimal results were achieved using an endocardial carbon-platinum-iridium prototype cathode and a short-duration biphasic waveform.
- This new electrode presents a promising alternative to titanium patches for specific patient populations.