A Patch in the Pectoral Position Lowers Defibrillation Threshold |
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Authors: | PAMELA KARASIK ALLEN SOLOMON RALPH VERDINO HANS MOORE DAVID RODAK ROBERT HANNAN ROSS FLETCHER |
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Institution: | VA Medical Center and Georgetown University Hospital, Washington, D.C. |
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Abstract: | Implantable pacemaker cardioverter defibrillators are now available with biphasic waveforms, which have been shown to markedly improve defibrillation thresholds (DFTs). However, in a number of patients the DFT remains high. Also, DFT may increase after implantation, especially if antiarrhythmic drugs are added. We report on the use of a subcutaneous patch in the pectoral position in 15 patients receiving a transvenous defibrillator as a method of easily reducing the DFT. A 660-mm2 patch electrode was placed beneath the generator in a pocket created on the pectoral fascia. The energy required for defibrillation was lowered by 56% on average, and the system impedance was lowered by a mean of 25%. This maneuver allowed all patients to undergo a successful implant with adequate safety margin. |
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Keywords: | defibrillation nonthoracofomy patch electrode |
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