Decreasing electrode size and increasing efficiency of cardiac stimulation

Furman, Seymour; Parker, Bryan; Escher, Doris J.W.

doi:10.1016/0022-4804(71)90032-1

Cited by 69 publications

(10 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Smaller endocardial pacing poles have been shown to create a smaller but more intense electrical field and this property is likely to apply to esophageal pacing poles as well. 10,17 The results of this study cannot be used to effectively discriminate between the individual importance of polar surface area and catheter shape. As such, further investigation is necessary in order to fully understand what effects polar surface and catheter shape may have on the efficacy of TAP.…”

Section: Discussionmentioning

confidence: 85%

“…7,9,11 Studies in people using endocardial pacing have demonstrated that as pole surface area decreases, current density increases and therefore lower thresholds can be obtained. 10 However, to the authors’ knowledge, there have been no studies evaluating the effect of catheter shape or pole size or shape on the efficacy of tranesophageal atrial pacing. In this study, we evaluated two readily available pacing catheters with different pole sizes and catheter shapes and found significant differences in the ability to achieve TAP and in the length of the total and clinical zones of atrial capture.…”

Section: Discussionmentioning

confidence: 99%

“…5,7–9 While there are no data about the effect of polar shape or surface area in TAP, endocardial pacing experiments have shown that poles with smaller surface areas create stronger current densities which allow for lower pacing thresholds compared to poles with larger surface areas. 10 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of two commercially available cardiac pacing catheters for transesophageal atrial pacing in dogs

Chapel

Sanders

2012

Journal of Veterinary Cardiology

View full text Add to dashboard Cite

Objective Compare the efficacy of two cardiac pacing catheters for transesophageal atrial pacing (TAP). Animals Ten healthy dogs. Methods Transesophageal atrial pacing was attempted in left lateral recumbency under general anesthesia. In series, a curved electrophysiologic (EP) catheter and a straight transesophageal pacing (TP) catheter were passed transorally into the distal esophagus, caudal to the heart. Each catheter was slowly withdrawn until pacing was initiated. The catheter continued to be withdrawn in 5 mm increments until capture was no longer achieved at maximal pacing setting creating a total zone of capture (tZOC). Minimum pacing threshold (Thmin) and degree of extraneous muscle stimulation (EMS) were determined at each site. Results The EP catheter achieved TAP in 10/10 dogs with a Thmin of 8.8 ± 4.8 mA and tZOC of 4.0 ± 1.7 cm. The TP catheter achieved TAP in 7/10 dogs with a Thmin of 22.5 ± 5.6 mA and tZOC of 1.2 ± 1.6 cm. No EMS was noted during TAP at Thmin using the EP catheter. Of the 7 dogs in which TAP was successful, 3/7 experienced considerable EMS at Thmin. There was no significant relationship between patient body weight and Thmin with either catheter (EP catheter P= 0.09; TP catheter P= 0.81) Conclusions The electrophysiology catheter captured the atria of more dogs over a larger area without EMS as compared to the TP catheter. The electrophysiology catheter is recommended for transesophageal atrial pacing in dogs.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of two commercially available cardiac pacing catheters for transesophageal atrial pacing in dogs

Chapel

Sanders

2012

Journal of Veterinary Cardiology

View full text Add to dashboard Cite

show abstract

“…The cathode in the majority of leads is an extendable helix that anchors the lead tip to the heart wall, and the anode is a ring electrode 10 mm proximal to the tip. To create larger antennas, thus optimizing sensing of existing electrical activity and delivery of adequate stimulatory impulses, the distance between electrodes and/or electrode size may be increased [44–46]. However, this carries inherent downsides.…”

Section: Limitations Of Existing Lead Technologymentioning

confidence: 99%

Advances in Cardiac Pacing: Beyond the Transvenous Right Ventricular Apical Lead

Kapa

Bruce

Friedman

et al. 2010

Cardiovascular Therapeutics

View full text Add to dashboard Cite

While for decades right ventricular (RV) apical pacing has been the standard of care for patients requiring pacemaker or defibrillator lead placement, investigators have sought alternatives to achieve more physiologic electrical activation of the heart and reduce long-term pathologic effects of nonphysiologic apical pacing. These investigations have included attempts at identifying superior pacing sites within the right atrium and RV and development of new leads to enhance specificity of sensing and capture. This review focuses on recent advances in alternative sites for pacing and developments in novel pacing technology ranging from intramyocardial electrodes to leadless pacemakers. First, there have been several studies demonstrating potential benefits of sitespecific pacing, including His bundle pacing and RV outflow tract pacing in potentially attenuating electromechanical dyssynchrony and long-term functional decline seen with RV apical pacing. Available options for lead placement have been enhanced by development of intramyocardial electrodes that may significantly reduce far-field oversensing and nonchamber specific capture. With development of intramyocardial electrodes, the potential for atrioventricular septal pacing has recently been described, making synchronous activation of both ventricles with a one-lead system possible without crossing the tricuspid valve and offering an alternative to modern cardiac resynchronization therapy (CRT). Finally, recent advances in leadless pacemaker systems using ultrasound or magnetic fields are briefly discussed. The results of these studies suggest that there may be options to the RV apex, made possible by novel lead and pacemaker technology. These advances can potentially aid in reducing long-term negative effects of chronic pacemaker therapy.

show abstract

“…Electrode/tissue interface impedances-Faraday resistance (Rj-' j and Helmholtz capacity fCnJ-were calculated from regression analysis of loaded and unloaded electrograms using the method of least squares. The Rf showed a fall from 14.7 ±1.4Kn to 5.2 ± 0.3 KU. and the Cff {20-40 Hz) rose from 6.0 ± 0.9^F to 15 load on a pulse generator and itS ability tO stimulate the heart.…”

mentioning

confidence: 96%

Temporary Pacemaker Treatment in Open Heart Surgery: Variation in Myocardial Threshold, Tissue and Interface Impedances in Man*

Ohm¹,

Mørkrid²,

Skagseth³

1979

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Myocardial threshold and impedance of adequately insulated multicore metal electrodes (lengths l1 and l2) were investigated in 28 patients undergoing open heart surgery. Increase in current threshold from the pre-to postoperative period was: 607 +/- 102% (mean +/- SEM) with a constant-current pulse generator and 885 +/- 129% with a constant-voltage pulse generator. Tissue impedance (RT - initial impendance) calculated as voltage/current ratio 90 mus into the pulse changed from 564 +/- 34 omega before surgery to a minimum of 134 +/- 7 omega. Thereafter, there was a gradual increase in RT to 162 +/- 9 omega the day of electrode removal. In 25 of 28 patients the minimum values were reached the third to eighth postoperative day. Electrode/tissue interface impedances--Faraday resistance (RF) and Helmholtz capacity (CH)--were calculated from regression analysis of loaded and unloaded electrograms using the method of least squares. The RF showed a fall from 14.7 +/- 1.4 K omega to 5.2 +/- 0.3 K omega, and the CH (20-40 Hz) rose from 6.0 +/- 0.9 mu F to 15.5 +/- 0.8 muF preoperatively to the day of minimum tissue impedance. There were no further changes until the day of electrode removal. A significant positive correlation was found between CH (p < 0.002), current threshold (p < 0.005) and equivalent electrode length [lequ = l1 X l2/(l1 + l2)]. The electrode signal source impedance calculated from RT, RF and CH was of a magnitude not likely to contribute to demand failures. The low postoperative electrode impendance resulted in excessive load on the constant-voltage generator (condenser discharge type), rendering stimulation of the heart with reasonable current values impossible.

show abstract

Decreasing electrode size and increasing efficiency of cardiac stimulation

Cited by 69 publications

References 2 publications

Efficacy of two commercially available cardiac pacing catheters for transesophageal atrial pacing in dogs

Efficacy of two commercially available cardiac pacing catheters for transesophageal atrial pacing in dogs

Advances in Cardiac Pacing: Beyond the Transvenous Right Ventricular Apical Lead

Temporary Pacemaker Treatment in Open Heart Surgery: Variation in Myocardial Threshold, Tissue and Interface Impedances in Man*

Contact Info

Product

Resources

About