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Lead system optimization for transvenous defibrillation

M R Gold¹, A H Foster, S R Shorofsky

¹Department of Medicine, University of Maryland School of Medicine, Baltimore, USA.

The American Journal of Cardiology

|November 14, 1997

Summary

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The triad lead system, combining a dual coil transvenous lead and active pectoral shell, significantly reduces defibrillation energy requirements. This optimization is crucial for developing smaller, more efficient implantable pulse generators.

Area of Science:

Cardiovascular Medicine
Biomedical Engineering
Electrophysiology

Background:

Active pectoral shells in lead systems lower defibrillation thresholds, enabling transvenous defibrillation.
Further enhancement of defibrillation efficacy is needed for smaller pulse generators with reduced output.

Purpose of the Study:

To compare defibrillation thresholds across multiple transvenous lead systems.
To identify the lead system that optimizes defibrillation energy requirements, including those with active pectoral shells.

Main Methods:

A prospective study involving 21 consecutive patients.
Evaluation of 3 randomized lead configurations: dual coil transvenous lead, unipolar (lead + pectoral shell), and triad (lead + pectoral shell + RV coil).
Measurement of delivered energy at defibrillation threshold, leading edge voltage, shock impedance, and peak current.

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Main Results:

The triad configuration demonstrated the lowest delivered energy at defibrillation threshold (7.8 J) compared to lead (11.2 J) and unipolar (10.1 J) configurations (p < 0.01).
The triad system also significantly decreased leading edge voltage (p < 0.01) and shock impedance (p < 0.001).
Peak current was minimized with the unipolar configuration (p < 0.01).

Conclusions:

The combination of a dual coil transvenous lead and an active pectoral shell significantly reduces defibrillation energy needs.
The triad lead system achieved defibrillation thresholds ≤15 J in all patients, indicating high efficacy.
This approach facilitates the development of smaller pulse generators with lower maximum output requirements.