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

Rashba, Eric J.; Farasat, Morteza; Kirk, Malcolm M.; Shorofsky, Stephen R.; Peters, Robert W.; Gold, Michael R.

doi:10.1111/j.1540-8167.2006.00374.x

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…[6][7][8][9] In these patient populations, a variety of innovative approaches to ICD implantation have been reported, including subcutaneous, epicardial and caval electrode placements and/or abdominal can implants (Figure 1). [7][8][9][10][11][12] Employing ad hoc adaptations of existing ICD components, these approaches attempt to minimize system invasiveness, incorporate patient specific options to adapt to complex anatomy, and achieve low defibrillation thresholds. Assumptions of efficacy are based on extrapolation of data from the use of subcutaneous arrays in adults, limited animal research and post-implantation assessment of defibrillation thresholds.…”

Section: Introductionmentioning

confidence: 99%

A computer modeling tool for comparing novel ICD electrode orientations in children and adults

et al. 2008

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Section: Introductionmentioning

confidence: 99%

A computer modeling tool for comparing novel ICD electrode orientations in children and adults

et al. 2008

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“…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.…”

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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Direct intracardiac placement of an automatic implantable cardioverter defibrillator coil lead in a small child

et al. 2007

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A 3.5-year-old child with hypertrophic obstructive cardiomyopathy and recurrent syncope underwent surgical left-ventricular outflow tract myectomy and implantation of a single-chamber automatic cardioverter defibrillator. A single-coil active fixation lead was introduced via a purse-string suture in the right atrial appendage and the lead tip positioned and fixed in the right-ventricular apex under direct visualization via a small right atriotomy incision. Described configuration may be considered in small children undergoing intracardiac surgery at the time of defibrillator implantation.

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

Cited by 3 publications

References 16 publications

A computer modeling tool for comparing novel ICD electrode orientations in children and adults

A computer modeling tool for comparing novel ICD electrode orientations in children and adults

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

Direct intracardiac placement of an automatic implantable cardioverter defibrillator coil lead in a small child

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