Bipolar Transvenous Defibrillation: Efficacy of Two Different Positions of the Anode |
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Authors: | MICHAEL BLOCK DIETER HAMMEL DIRK BÖCKER MARTIN BORGGREFE THOMAS BUDDE MARCO CASTRUCCI CHRISTIAN FASTENRATH HANS H SCHELD GUNTER BREITHARDT |
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Institution: | Hospital of the Westfälische Wilhelms, University of Munster, Department of Cardiology/Angiology;Department of Cardiovascular Surgery and Institute for Research in Arteriusdorosis, Münster, Germany |
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Abstract: | For most nonthoracotomy defibrillotion lead systems, the transvenous anode can be 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). There-fort, 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) 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 ≤ 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 Ω vs 52 ± 7 Ω). Thus, defibrillation is not improved in general although individual patients might benefit. |
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Keywords: | defibrillation implantable cardioverter defibrillator ventricular fibrillation nonthoracotomy defibrillation leads |
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