Bipolar transvenous defibrillation: efficacy of two different positions of the anode

For most nonthoracotomy defibrillation lead systems, the transvenous anode can positioned independently of the right ventricular (RV) cathode. Usually a vertical position in the superior vena cava (SVC) is chosen. However, it is unknown if this position yields the optimal defibrillation threshold (DFT). Therefore, in 15 patients undergoing defibrillator implantation the SVC position was compared in a crossover study design with a horizontal position in the left brachiocephalic vein (BCV). Mean DFT was not different for SVC and BCV (19.2 +/- 9.6 J vs 18.5 +/- 9.1 J) but DFT of individual patients differed by up to 12 joules. A positive correlation between impedance and DFT in the BCV position (r = 0.6; P < or = 0.05) indicated that the improved geometry of the defibrillation field with the BCV position is opposed by a higher impedance found for this position (63 +/- 15 omega vs 52 +/- 7 omega). Thus, defibrillation is not improved in general although individual patients might benefit.