Initial Clinical Experience With Endocardial Defibrillation Using an Implantable Cardioverter/Defibrillator With a Triple-Electrode System

Saksena, Sanjeev

doi:10.1001/archinte.1989.00390100133028

Cited by 79 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This has been subsequently confirmed during implant procedures for such lead sys tems. Our reported experience and a recent multicenter data analysis indicated highest implant rates (ranging from 69 to 90%) and lowest defibrillation thresholds with the tri ple-electrode configuration [25,26]. In our patients, the mean defibrillation threshold was 18 J.…”

Section: Technologic Advancessupporting

confidence: 47%

See 1 more Smart Citation

Current Application of Implantable Cardioverter-Defibrillators in the Management of Malignant Ventricular Tachyarrhythmias

Saksena¹

1990

Cardiology

Self Cite

View full text Add to dashboard Cite

Several studies have uniformly demonstrated a marked reduction in expected arrhythmic/sudden death rates in patients with either drug-refractory sustained ventricular tachycardia, ventricular fibrillation or survivors of cardiac arrest following the implantation of cardioverter-defibrillators (ICD). Significant advances in these devices over the past 10 years have permitted programmability and demand pacing. There has been sophistication in tachycardia detection and the characteristics of the delivered electrical therapy. Programs to reconfirm the arrhythmic event, sensing parameters for rate, electrogram amplitude, data storage, interrogation and morphology are available in some devices. Some models will permit both antitachycardia pacing as well as defibrillation functions and choice of shock waveforms as bidirectional and biphasic shocks. Endocardial lead systems using smaller and more flexible electrodes may obliterate the need for thoracotomy. It appears that ICD therapy will form a significant component in antiarrhythmic therapy in the future.

show abstract

Section: Technologic Advancessupporting

confidence: 47%

“…The Endotak lead system was as sociated with several incidents of stress frac ture of the conductor coil for both transve nous catheter and patch electrodes [25]. This was manifest as inappropriate shocks, failure to defibrillate at electrophysiologic testing, and even sudden death in one patient.…”

Section: Technologic Advancesmentioning

confidence: 99%

Current Application of Implantable Cardioverter-Defibrillators in the Management of Malignant Ventricular Tachyarrhythmias

Saksena¹

1990

Cardiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…1,2 Although present ICD systems using RV leads provide excellent performance, DFTs might be substantially reduced if electric field strength to the LV could be increased. A variety of electrodes, such as subcutaneous patches and arrays, 8,9 active pulse generator "cans," 10 and coils in the CS, 11 have been studied clinically. These approaches typically produce moderate DFT reductions of 20% to 30% and, although many probably increase the electric field strength on the LV, they do not specifically place an electrode in the middle of the LV free wall.…”

Section: Prior Studiesmentioning

confidence: 99%

“…However, their study required the addition of both a CS lead and a subcutaneous patch, did not include the subcutaneous patch (or an active can) as part of the control system, and used 2 biphasic waveforms of equal amplitude (thereby requiring an ICD with 2 sets of discharge capacitors). Because other studies have shown the addition of a subcutaneous patch or active can alone reduces DFTs by 25% to 30%, 8,10 it is unclear how much the addition of a CS lead and sequential shocks might have contributed to the DFT reduction. Our study used a modern, clinically relevant, 3-electrode active can system as a control and showed an additional DFT reduction of 45% using the LV lead and dual-shock waveform.…”

Section: Prior Studiesmentioning

confidence: 99%

Transvenous Biventricular Defibrillation Halves Energy Requirements in Patients

et al. 2001

View full text Add to dashboard Cite

Background-Defibrillation thresholds (DFT) with standard implantable cardioverter-defibrillator leads in the right ventricle (RV) may be determined by weak shock field intensity in the myocardium of the left ventricle (LV). Adding a shocking electrode in a coronary vein on the middle of the LV free wall, thereby establishing biventricular defibrillation, substantially reduced defibrillation requirements in animals. We investigated the feasibility of this approach in 24 patients receiving an implantable cardioverter-defibrillator using a prototype over-the-wire temporary LV defibrillation lead. Methods and Results-The LV lead was inserted through the coronary sinus, using a guide catheter and guidewire, into a posterior or lateral coronary vein whose location was determined by retrograde venography. Paired DFT testing compared a standard system (RV to superior vena cava plus can emulator [SVCϩCan], 60% tilt biphasic shock) to a system including the LV lead. The biventricular system was tested with a dual-shock waveform (20% tilt monophasic shock from LV3 SVCϩCan, then 60% tilt biphasic shock from RV3 SVCϩCan). Twenty patients completed DFT testing. Venography and LV lead insertion time was 46Ϯ40 minutes. The biventricular system reduced mean DFT by 45% (8.9Ϯ1.1 J versus 4.9Ϯ0.5 J, PϽ0.001). Twelve patients (60%) had a standard system DFT Ն8 J, and the biventricular system gave a lower DFT in all patients. There were no adverse events related to the use of the LV lead, which was removed after testing. Conclusions-Internal defibrillation using a transvenously inserted LV lead is feasible, produces significantly lower DFTs, and seems safe under the conditions tested. Biventricular defibrillation may be a useful option for reducing DFTs or could be added to an LV pacing lead for heart failure.

show abstract

“…8 Patients who had this lead suffered multiple inappropriate shocks, and it was withdrawn from clinical trial. Since then, conductor fractures and insulation disruption have challenged engineers and physicians to develop improved designs and implant techniques.…”

Section: Article P 2122mentioning

confidence: 99%

A Better Method for Preventing Adverse Clinical Events Caused by Implantable Cardioverter-Defibrillator Lead Fractures?

Hauser

2008

Circulation

View full text Add to dashboard Cite

Initial Clinical Experience With Endocardial Defibrillation Using an Implantable Cardioverter/Defibrillator With a Triple-Electrode System

Cited by 79 publications

References 16 publications

Current Application of Implantable Cardioverter-Defibrillators in the Management of Malignant Ventricular Tachyarrhythmias

Current Application of Implantable Cardioverter-Defibrillators in the Management of Malignant Ventricular Tachyarrhythmias

Transvenous Biventricular Defibrillation Halves Energy Requirements in Patients

A Better Method for Preventing Adverse Clinical Events Caused by Implantable Cardioverter-Defibrillator Lead Fractures?

Contact Info

Product

Resources

About