Optimization of superior vena cava coil position and usage for transvenous defibrillation

Gold, Michael R.; Val-Mejias, Jesus E.; Leman, Robert B.; Tummala, Rangarao; Goyal, Sanjeev B.; Kluger, Jeffrey; Kroll, Mark W.; Oza, Ashish

doi:10.1016/j.hrthm.2007.12.001

Cited by 33 publications

(23 citation statements)

References 17 publications

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“…9,10 One of the three studies required the use of a binary search protocol guided by upper limit of vulnerability and 28% of the data contributing to this analysis came from that study. 11 The defibrillation waveform for all patients was programmed to the optimal pulse width settings based on a theoretical 3.5 ms membrane time constant using a commercially available chart of optimal defibrillation pulse width (Phase 1/Phase 2) durations.…”

Section: Methodsmentioning

confidence: 99%

Does defibrillation threshold increase as left ventricular ejection fraction decreases?

Oza

2010

Europace

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AimsAdvanced cardiac disease, entailing more hypertrophy, fibrosis, scarring, dilatation and conduction delays, poses the question of whether defibrillation thresholds (DFTs) increase as left ventricular ejection fraction (LVEF) decreases. This question has been approached indirectly or insufficiently in previous studies. In this study we add and expand on our previous work, stratifying DFT for various LVEF ranges.Methods and resultsThis retrospective analysis included DFT data from three acute, multicentre, randomized studies that included 230 ICD/CRT-D patients. All DFTs were obtained with the SVC coil turned ON and with pulse-width optimized waveforms based on a 3.5 ms membrane time constant. As the LVEF decreased, DFT estimates increased from 395.2 ± 115 V for LVEF ≥ 46% to 425.8 ± 117.6 V for LVEF ≤ 25%. However, these changes in DFT estimates were very minor and not statistically significant. Only 3% of the patients in this population had an elevated DFT of >20 J.ConclusionThis analysis shows that over a very broad range of LVEF, DFT changes minimally (approximately 1 J), if at all. Our results are consistent with previous studies that demonstrated no difference in the DFT estimates: (a) between patient groups receiving ICD (typically higher LVEF) vs. CRT-D (typically lower LVEF) and (b) between patient groups receiving a device for primary prevention indications (typically lower LVEF) vs. secondary prevention indications (typically higher LVEF).

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Section: Methodsmentioning

confidence: 99%

Does defibrillation threshold increase as left ventricular ejection fraction decreases?

Oza

2010

Europace

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“…In the case of inadequate energy safety margins during the implantation of a single-coil lead system, the substitution to a dual-coil lead might be effective in the presence of an elevated single-coil shock impedance. This impedance threshold depends on the used defibrillation shock waveform (fix-tilt or fix-duration waveforms) [23,38].…”

Section: Defibrillation Testing At the Time Of Device Implantationmentioning

confidence: 99%

“…In the four studies by Gold et al [19][20][21]23] dualcoil lead systems resulted in a mean DFT in the range from 7.8 ± 3.6 to 9.2 ± 5.8 J. The mean DFTs with single-coil leads ranged from 10.1 ± 5 to 11.2 ± 6.6 J.…”

Section: Introductionmentioning

confidence: 96%

Dual- versus single-coil implantable defibrillator leads: review of the literature

Neuzner

Carlsson

2012

Clin Res Cardiol

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The preferred use of dual-coil implantable defibrillator lead systems in current implantable defibrillator therapy is likely based on data showing statistically lower defibrillation thresholds with dual-coil defibrillator lead systems. The following review will summarize the clinical data for dual- versus single-coil defibrillator leads in the left and right pectoral implant locations, and will then discuss the clinical implications of single- versus dual-coil usage for atrial defibrillation, venous complications, and the risks associated with lead extraction. It will be noted that there are no comparative clinical studies on the use and outcomes of single- versus dual-coil lead systems in implantable defibrillator therapy over a long-term follow-up. The limited long-term reliability of defibrillator leads is a major concern in implantable defibrillator and cardiac resynchronization therapy. A simpler single-coil defibrillator lead system may improve the long-term performance of implanted leads. Furthermore, the superior vena cava coil is suspected to increase interventional risk in transvenous lead extraction. Therefore, the need for objective data on extractions and complications will be emphasized.

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“…More recent analyses indicate that the effect of a dual-coil lead depends on multiple factors, including location of the proximal electrode (superior vena cava, innominate junction superior to right atrium), shock waveform, and location of pulse generator (right-vs. left-sided). 59,60 Atrial cardioversion is more effective with dual-coil than with singlecoil leads. EGMs recorded between the proximal coil and ICD housing record atrial signals that are useful for physician interpretation of single-chamber-stored EGMs and may replace surface ECG electrodes during follow-up.…”

Section: Dual-coil Versus Single-coil Defibrillation Leadsmentioning

confidence: 99%

Implantable Cardioverter Defibrillator

Swerdlow¹,

Friedman²

2014

Cardiac Electrophysiology: From Cell to Bedside

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Optimization of superior vena cava coil position and usage for transvenous defibrillation

Cited by 33 publications

References 17 publications

Does defibrillation threshold increase as left ventricular ejection fraction decreases?

Does defibrillation threshold increase as left ventricular ejection fraction decreases?

Dual- versus single-coil implantable defibrillator leads: review of the literature

Implantable Cardioverter Defibrillator

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