Circulation, Vol 88, 543-547, Copyright © 1993 by American Heart Association
GH Bardy, G Johnson, JE Poole, GL Dolack, PJ Kudenchuk, D Kelso, R Mitchell, R Mehra and B Hofer
BACKGROUND. Transvenous implantable cardioverter-defibrillators provide
significant advantages in the treatment of patients with life- threatening
ventricular arrhythmias. However, present technology requires considerable
electrophysiology expertise, multiple incisions, and long operative times
for successful implementation. METHODS AND RESULTS. In this study, we
present a prototype of a new, easy-to-insert unipolar transvenous
defibrillation system that has the reliability of epicardial defibrillation
but the ease of pacemaker insertion. This system incorporates a single
anodal right ventricular defibrillation electrode using a 65% tilt biphasic
pulse delivered to a 108-cm2 surface area pulse generator titanium alloy
shell as an active cathode placed in a left infraclavicular pocket. Testing
of this system was performed before implantation of a standard
nonthoracotomy-transvenous defibrillation system in 40 consecutive patients
with a history of ventricular tachycardia or fibrillation. The simplified
unipolar single- lead system resulted in a defibrillation threshold of 9.3
+/- 6.0 J with 37 of 40 patients (93%) having a defibrillation threshold of
less than 20 J. Moreover, the unipolar defibrillation system was
efficiently used requiring only 3.4 +/- 0.8 ventricular fibrillation
inductions to measure the defibrillation threshold and 100 +/- 28 minutes
to implement. CONCLUSIONS. This new unipolar transvenous defibrillation
system is as simple to insert as a pacemaker, requires few ventricular
fibrillation inductions, demands less technical expertise, and provides
defibrillation at energy levels comparable to that reported with epicardial
lead systems. It should substantially reduce the morbidity, time, and cost
of defibrillator implantation.
ARTICLES
A simplified, single-lead unipolar transvenous cardioversion- defibrillation system
Department of Medicine, University of Washington, Seattle.
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