Comparison of a unipolar defibrillation system with a dual lead system using an enlarged defibrillation anode

The unipolar system for transvenous defibrillation, consisting of a single right ventricular lead as the cathode and the device shell as anode, has been shown to combine low defibrillation thresholds (DFTs) and simple implantation techniques. We compared the defibrillation efficacy of this system with the defibrillation efficacy of a dual lead system with a 12-cm long defibrillation anode placed in the left subclavian vein. The data of 38 consecutive patients were retrospectively analyzed. The implantation of an active can system was attempted in 20 patients (group 1), and of the dual lead system in 18 patients (group 2). Both groups had comparable demographic data, cardiac disease, ventricular function, or clinical arrhythmia. The criterion for successful implantation was a DFT of < or = 24 J. This criterion was met in all 18 patients of group 2. The active can system could not be inserted in 3 of the 20 group 1 patients because of a DFT > 24 J. In these patients, the implantation of one (n = 2) or two (n = 1) additional transvenous leads was necessary to achieve a DFT < or = 24 J. The DFTs of the 17 successfully implanted group 1 patients were not significantly different from the 18 patients in group 2 (12.3 +/- 5.7 J vs 10.8 +/- 4.8 J). The defibrillation impedance was similar in both groups (50.1 +/- 6.1 omega vs 48.9 +/- 5.2 omega). In group 1, both operation duration (66.8 +/- 17 min vs 80.8 +/- 11 min; P < 0.05) and fluoroscopy time (3.3 +/- 2.1 min vs 5.7 +/- 2.9 min; P < 0.05) were significantly shorter. Thus, the active can system allows reliable transvenous defibrillation and a marked reduction of operation duration and fluoroscopy time. The dual lead system, with an increased surface area defibrillation anode, seems to be a promising alternative for active can failures.