Transvenous Biventricular Defibrillation Halves Energy Requirements in Patients
| Autor: | Bernd Schubert, Christian Butter, Dietrich Pfeiffer, Eckart Fleck, Stephen J. Hahn, Lothar Engelmann, Eckhard Meisel, Juergen Tebbenjohanns |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Defibrillation Heart Ventricles medicine.medical_treatment Venography Coronary Angiography Physiology (medical) Internal medicine medicine Humans Ventricular Function Coronary sinus Heart Failure Coronary Vein medicine.diagnostic_test business.industry Middle Aged medicine.disease Coronary Vessels Defibrillators Implantable Electrophysiology medicine.anatomical_structure Ventricle Shock (circulatory) Heart failure Ventricular fibrillation Cardiology Feasibility Studies Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 104:2533-2538 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | 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 [SVC+Can], 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 LV→SVC+Can, then 60% tilt biphasic shock from RV→SVC+Can). Twenty patients completed DFT testing. Venography and LV lead insertion time was 46±40 minutes. The biventricular system reduced mean DFT by 45% (8.9±1.1 J versus 4.9±0.5 J, P 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. |
| Databáze: | OpenAIRE |
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