Electrode system influence on biphasic waveform defibrillation efficacy in humans.

Bardy, Gust H.; Troutman, Charles; Johnson, George; Mehra, Rahul; Poole, Jeanne E.; Dolack, G. Lee; Kudenchuk, Peter J.; Gartman, David M.

doi:10.1161/01.cir.84.2.665

Cited by 49 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prior research has demonstrated, for example, that the increased defibrillation efficacy of biphasic versus monophasic waveforms is influenced by electrode configuration. 16 Further, the optimal phase 1 duration and capacitance may vary with electrode configu-ration and pathway resistance. 10,17 Perhaps most importantly, because these conflicting studies used a much smaller sample size (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) patients) than the current study, they would have had a low probability of detecting 10%-15% differences in defibrillation efficacy.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Comparison of 50%/50% Versus 65%/65% Tilt Biphasic Waveform on Defibrillation in Humans

Sweeney

Volosin

Swerdlow

et al. 2001

Pacing Clinical Electrophis

View full text Add to dashboard Cite

It is unknown if there is a single optimal biphasic waveform for defibrillation. Biphasic waveform tilt may be an important determinant of defibrillation efficacy. The purpose of this study was to compare acute defibrillation success with a three-electrode configuration in humans using 50%/50% versus 65%/65% tilt truncated exponential, biphasic waveforms delivered through a 110-microF capacitor. Acute DFTs for biphasic waveforms with 50%/50% versus 65%/65% tilt were measured in random order in 60 patients using a binary search method. The electrode configuration consisted of a RV coil as the cathode, and a SVC coil plus a pectoral active can emulator (CAN) as the anode. The waveforms were derived from an external voltage source with 110-microF capacitance, and the leading edge voltage of phase 2 was equal to the trailing edge voltage of phase 1. Stored energy DFT (9.2 +/- 5.7 [50%/50%] vs 10.8 +/- 6.4 [65%/65%] J, P = 0.007), current DFT (10.9 +/- 4.0 [50%/50%] vs 12.0 +/- 4.4 [65%/65%] A, P = 0.002) and voltage DFT (391 +/- 118 [50%/50%] vs 424 +/- 128 [65%/65%] V, P = 0.004) were significantly lower for the 50%/50% tilt waveform versus the 65%/65% tilt waveform using this three-electrode configuration and a 110-microF capacitor. For an RV(-)/SVC plus CAN(+) electrode configuration and a 110-microF capacitor, a 50%/50% tilt biphasic waveform results in a 15% reduction in energy DFT, 9% reduction in current DFT, and 8% reduction in voltage DFT versus a 65%/65% tilt biphasic waveform.

show abstract

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Comparison of 50%/50% Versus 65%/65% Tilt Biphasic Waveform on Defibrillation in Humans

Sweeney

Volosin

Swerdlow

et al. 2001

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…First, the unipolar pulsing method uses a biphasic waveform, and this particular biphasic waveform has been shown to improve defibrillation efficacy in previous studies.15 17,20 Second, the current vector is directed from right to left and inferior to superior. Depending on the RV defibrillation coil location on the diaphragmatic surface of the right ventricle, the current also may be directed through the heart in a posterior to anterior direction.…”

Section: Discussionmentioning

confidence: 99%

Prospective, randomized comparison in humans of a unipolar defibrillation system with that using an additional superior vena cava electrode.

et al. 1994

Self Cite

View full text Add to dashboard Cite

show abstract

“…These trials focus on searching for optimal forms of defibrillation impulse, as well as on the development of properties and placement of defibrillation leads. 1,3,11,17,19,25,30 Optimization of the lead system and positioning aims to lower the voltage defibrillation threshold (V th ), or minimum shock strength needed to eliminate fibrillatory wavefronts, so as to increase success rates for defibrillation shocks, decrease myocardial tissue damage, and increase the lifespan of the ICDs. 12,13,22,28,31 Because defibrillation mechanisms are still largely not understood and experimental studies are difficult to conduct due to the need to test numerous electrode positions, computer models have been applied for the optimization analysis.…”

Section: Introductionmentioning

confidence: 99%

Optimal Transvenous Coil Position on Active-can Single-coil ICD Defibrillation Efficacy: A Simulation Study

Yang

Patterson

2008

Ann Biomed Eng

View full text Add to dashboard Cite

The implantable cardioverter defibrillator with an active can and a single coil lead is effective in treating ventricular fibrillation, but the lead placement associated with the high defibrillation efficacy is still controversial and remains largely empirical. In this study, an anatomically realistic finite difference model of the thorax was developed based on MRI cross-sectional images of a human thorax to examine the effect of transvenous coil placement on defibrillation efficacy. Four electrode configurations with the coil was placed, respectively, in the right ventricular (RV) apex, in the middle of RV cavity, along the free wall in RV, or along the septal wall in RV, were simulated and their defibrillation efficacies were evaluated based on a set of metrics including voltage defibrillation threshold, current defibrillation threshold, interelectrode impedance, potential gradient distribution uniformity, current density distribution, and myocardium damage. It was found that the optimal electrode configuration is to position the coil in the middle of the RV cavity. The results were compared with the results from a simplified thoracic model. The comparison indicates that for a given electrode configuration a simplified representation of the thorax may overestimate defibrillation efficacy.

show abstract

Electrode system influence on biphasic waveform defibrillation efficacy in humans.

Cited by 49 publications

References 21 publications

Prospective Randomized Comparison of 50%/50% Versus 65%/65% Tilt Biphasic Waveform on Defibrillation in Humans

Prospective Randomized Comparison of 50%/50% Versus 65%/65% Tilt Biphasic Waveform on Defibrillation in Humans

Prospective, randomized comparison in humans of a unipolar defibrillation system with that using an additional superior vena cava electrode.

Optimal Transvenous Coil Position on Active-can Single-coil ICD Defibrillation Efficacy: A Simulation Study

Contact Info

Product

Resources

About