Comparison of the effects of active left and right pectoral pulse generators on defibrillation efficacy

Kirk, Malcolm M.; Shorofsky, Stephen R.; Gold, Michael R.

doi:10.1016/s0002-9149(01)02096-3

Cited by 12 publications

(7 citation statements)

References 18 publications

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“…We previously observed similar results when the effect of an active right pectoral can on DFTs was investigated 13 . In contrast, when a left pectoral active can is used with a dual‐coil lead, peak current is unchanged and shock impedance is markedly reduced, resulting in a large improvement in DFT energy 4,13 . Taken together, these data indicate that adding an Active Can to a dual‐coil transvenous lead will uniformly reduce shock impedance, since another pathway for current flow is present.…”

Section: Discussionsupporting

confidence: 67%

“…Since the shocking impedance was reduced by the addition of another electrode to the system, no net effect on DFT energy was observed. We previously observed similar results when the effect of an active right pectoral can on DFTs was investigated 13 . In contrast, when a left pectoral active can is used with a dual‐coil lead, peak current is unchanged and shock impedance is markedly reduced, resulting in a large improvement in DFT energy 4,13 .…”

Section: Discussionsupporting

confidence: 54%

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Effect of an Active Abdominal Pulse Generator on Defibrillation Thresholds with a Dual‐Coil, Transvenous ICD Lead System

Rashba¹,

Farasat²,

Kirk³

et al. 2006

Cardiovasc electrophysiol

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Section: Discussionsupporting

confidence: 67%

Section: Discussionsupporting

confidence: 54%

Effect of an Active Abdominal Pulse Generator on Defibrillation Thresholds with a Dual‐Coil, Transvenous ICD Lead System

Rashba¹,

Farasat²,

Kirk³

et al. 2006

Cardiovasc electrophysiol

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“…In the study of Kirk [7] one fourth (25) of the patients received right-sided implants of ICDs. The study population is rather small.…”

Section: Discussionmentioning

confidence: 99%

Significance of intraoperative testing in right-sided implantable cardioverter-defibrillators

Keyser

Hilker

Ücer

et al. 2013

J Cardiothorac Surg

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BackgroundImplantation of implantable cardioverter-defibrillators (ICD) from the left pectoral region is the standard therapeutical method. Increasing numbers of system revisions due to lead dysfunction and infections will consecutively increase the numbers of right-sided implantations. The reliability of devices implanted on the right pectoral side remains controversially discussed, and the question of testing these devices remains unanswered.MethodsIn a prospectively designed study all 870 patients (60.0±14 years, 689 male) who were treated with a first ICD from July 2005 until May 2012 and tested intraoperatively according to the testing protocol were analyzed. The indication for implantation was primary prophylactic in 71.5%. Underlying diseases included ischemic cardiomyopathy (50%), dilative cardiomyopathy (37%), and others (13%). Mean ejection faction was 27±12%. Implantation site was right in 4.5% and left in 95.5%.ResultsFive patients supplied with right-sided ICD (13%, p = 0.02 as compared to left-sided) failed initial intraoperative testing with 21 J. 3 patients were male. The age of the patients failing intraoperative testing with right-sided devices appeared higher than of patients with left-sided devices (p = 0.07). The ejection fraction was 28±8%. All patients reached a sufficient DFT ≤ 21 J after corrective procedures.ConclusionImplantation of ICDs on the right side results in significantly higher failure rate of successful termination of intraoperatively induced ventricular fibrillation. The data of our study suggest the necessity of intraoperative ICD testing in right-sided implanted ICDs.

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“…Even today, young children at risk for sudden death are often too small for pectoral implants and the abdominal approach is still used. In addition, it is not uncommon to implant devices in the right pectoral area, which may cause a shock vector that has not been as well studied as the left pectoral approach 3 …”

Section: Editorial Commentmentioning

confidence: 99%

Can Incremental Innovation of Implantable Cardioverter‐Defibrillator Systems Become Disruptive to Patient Care? Moore's Law Gone Awry

Naccarelli

2006

Cardiovasc electrophysiol

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Implantable cardioverter-defibrillator (ICD) implantation has evolved from a thoracotomy approach, with shock patches attached to the epicardium, to a more limited thoracotomy using a subxiphoid approach, and finally to the endocardial insertion of pacing and shock leads with prepectoral insertion of the ICD generator similar to a pacemaker. In the mid-1990s, there was a period of time when leads could be endocardially placed, yet the ICD generators were too large (4-7 times the size and weight of today's generators) for a pectoral approach implant. To take advantage of endocardial leads, ICD generators were implanted above the rectus sheath muscles, and the pacing and shock leads were tunneled from the subclavian or cephalic vein insertion site, subcutaneously to the ICD generator site. Over 10 years later, many of these patients are still alive and undergoing their second or third ICD generator replacement for end-of-life indications. Most original implants utilized dual lead shocking coils, predating active can technology. Given the fact that these lead systems are still intact, replacement of just the ICD generator without a whole new lead system is preferred.Rashba et al., 1 in a study of 39 patients who presented for routine abdominal ICD pulse generator replacement, prospectively studied whether an active abdominal ICD pulse generator could affect defibrillation threshold testing (DFT) with a dual coil transvenous ICD lead system (Guidant ENDOTAK ). The lead alone configuration tested used the right ventricular coil as the anode with the proximal superior vena caval coil as the cathode. In the active can configuration, the superior vena cava coil and can were connected as the cathode. The active can configuration was associated with a significant decrease (P < 0.001) in shock impedance, a significant increase (P < 0.01) in peak current with no significant difference in DFT or leading edge voltage. A DFT safety margin of >10 joules was present in all patients. Currently available ICD generators are only available with active can technology. These data support the use of such active cans with the lead system studied, avoiding an ICD reconfiguration, explantation of a lead, and an additional pectoral generator implant as part of the revision. The above study confirms similar findings from Neuzner et al., 2 who studied the above during acute implantation of the ICD and used an opposite polarity than Rashba et al. Of note is that Rashba et al. demonstrated an increase in current suggesting that the defibrillation vector is worsened when an abdominal activecan ICD is used with a dual coil transvenous lead. Of course, by adding the second electrode into the defibrillation system, shock impedance was lowered with no net effect on DFT energy.ICD technology will continue to evolve. Current lead systems may remain intact for greater than 10-20 years. Thus, multiple generator replacements can occur using the same lead system if the patient lives long enough and lead integrity is maintained. Even today, young children ...

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Comparison of the effects of active left and right pectoral pulse generators on defibrillation efficacy

Cited by 12 publications

References 18 publications

Effect of an Active Abdominal Pulse Generator on Defibrillation Thresholds with a Dual‐Coil, Transvenous ICD Lead System

Effect of an Active Abdominal Pulse Generator on Defibrillation Thresholds with a Dual‐Coil, Transvenous ICD Lead System

Significance of intraoperative testing in right-sided implantable cardioverter-defibrillators

Can Incremental Innovation of Implantable Cardioverter‐Defibrillator Systems Become Disruptive to Patient Care? Moore's Law Gone Awry

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