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Comparison of simultaneous versus sequential defibrillation pulsing techniques using a nonthoracotomy system.

H H Hsia·R B Kleiman·B T Flores·F E Marchlinski
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Abstract

The defibrillation threshold (DFT) using simultaneous (SIML) versus sequential (SEQ) pathways for shock delivery was compared in 16 patients with an implanted cardioverter defibrillator. All patients had three-lead nonthoracotomy systems (NTL) using a left chest subcutaneous patch, a right ventricular endocardial lead, and a lead in the coronary sinus (n = 5) or superior vena cava (n = 11). The DFT were determined 2-44 days (17 +/- 17 days) after implantation. The DFT was defined as the lowest energy shock that resulted in successful defibrillation. The first pathway tested was SIML in 12 and SEQ in 4 patients with output beginning at or above the intraoperative DFT, routinely 18 J. The second pathway was tested beginning 2-4 J above the DFT of the first tested pathway. All shocks were delivered in 2-4 J decrement or increment steps. The SEQ pathway shocks resulted in a significantly lower DFT than SIML pathway shocks (14 +/- 6 vs 18 +/- 6 J; P < 0.01). There was no difference in the time delay after ventricular fibrillation initiation before shock delivery for the successful defibrillation between SIML versus SEQ pathways (7 +/- 2 secs for both pathways). In 7 of 16 patients, defibrillation using SEQ pathway resulted in a > 5 J lowering of DFT, while only one patient had > 5 J lowering of DFT using SIML shocks (P < 0.05). These results have important implications for selecting the optimal pathway for implantable cardioverter defibrillator therapy with a multilead NTL system.

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AdultAgedAged, 80 and overCoronary VesselsDefibrillators, ImplantableElectric CountershockEquipment DesignFemaleHeart VentriclesHumansMaleMiddle AgedTachycardia, VentricularThoracotomyVena Cava, SuperiorVentricular FibrillationComparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, P.H.S.

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H H Hsia, R B Kleiman, B T Flores, F E Marchlinski. 1994. Comparison of simultaneous versus sequential defibrillation pulsing techniques using a nonthoracotomy system.. https://doi.org/10.1111/j.1540-8159.1994.tb01489.x

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