Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Effect of the addition of an abdominal hot can cardioverter/defibrillator pulse generator on the defibrillation energy requirements in a single-lead endocardial defibrillation system
Department of cardiology, Kerckhoff Clinic, Max Planck Institute for Physiological and Clinical Research Bad Nauheim, Germany
Received 28 April 1997; accepted 5 May 1997.
Correspondence: Jörg Neuzner, MD, Department of Cardiology, Kerckhoff-Clinic, Max Planck Institute for Physiological and Clinical Research, Beneke Strasse 2-8, 61231 Bad Nauheim, Germany
Abstract
AIMS: The effects of a cardioverter/defibrillator system with an electrically active generator can, applied without recourse to thoracotomy, have not been investigated in the abdominal position in humans. The purpose of this acute clinical study was to evaluate the defibrillation efficacy of an abdominally positioned hot can electrode in connection with a single lead endocardial defibrillation system.
PATIENTS AND METHODS: Thirty consecutive patients undergoing implantation of a cardioverter/defibrillator or pulse generator replacement were enrolled in this study. Each patient received an integrated, tripolar single-lead system. This was tested using an asymmetrical biphasic defibrillation waveform with constant energy delivery. Defibrillation energy, peak voltage, peak current and impedance were compared between two electrode configurations; (A) in this configuration the distal right ventricular coil was negative and the proximal coil positive; (B) in this configuration the distal right ventricular coil was negative and the proximal coil and the abdominal hot can (65 ccm), as common anode, were positive. Defibrillation threshold testing started at 15 J with stepwise energy reduction (10 J, 8 J, 5 J and 3 J) until defibrillation was ineffective.
RESULTS: Compared to the single-lead configuration, the abdominal hot can configuration revealed at 17·5% reduction in defibrillation energy requirements (8·6 J±4·3J vs 10·43 J+3·9 J; P=0·041), a 15·7% reduction in peak voltage (308·6±63 V vs 365·3V±68V; P0·003), and a 21·6% reduction in impedance (41·1
±6·3 vs 52·4±6·6·6; P>0·001). Peak current showed a significant increase during hot can testing of 8·2% (7·2 A+1·8 A vs 7·8 A±2·2 A; P=0·16).
CONCLUSIONS: An abdominally placed hot can pulse generator lowered defibrillation energy requirements in patients with an endocardial defibrillation lead system.
Key Words: Cardioverter-defibrillator • transvenous lead system • abdominal hot can pulse generator
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  A.J. Solomon, J.B. Moubarak, J.M. Drood, C.M. Tracy, and P.E. Karasik An abdominal active can defibrillator may facilitate a successful generator change when a lead failure is present Europace, January 1, 1999; 1(4): 266 - 269. [Abstract] [PDF]
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