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A randomized comparison of defibrillation thresholds in the right ventricular outflow tract versus right ventricular apex

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Objective

To determine whether the placement of an implantable cardioverter–defibrillator (ICD) lead in the right ventricular outflow tract (RVOT) has the same defibrillation threshold (DFT) as the right ventricular apex (RVA).

Background

Right ventricular ICD leads have usually been placed in the RVA. Development of active fixation technology has allowed the placement of these leads in alternate locations such as the RVOT.

Methods

At time of device implantation, 26 patients with either ischemic or dilated cardiomyopathy underwent DFT testing in both the RVA and RVOT using a binary search algorithm.

Results

Placement of the lead in the RVA had a mean DFT of 7.6 ± 2.8 J while the placement of the lead in the RVOT had a mean DFT of 10.3 ± 3.0 J. The median (25th and 75th percentiles) DFTs in the RVA and RVOT were 7.5 J (6 and 11 J) and 11 J (9 and 14 J), respectively (p = 0.0002).

Conclusions

Placement of the right ventricular lead in the RVA has a significantly lower DFT than placement of the lead in the RVOT.

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References

  1. Askenazi, J., Alexander, J. H., Koenigsberg, D. I., Belic, N., & Lesch, M. (1984). Alteration of left ventricular performance by left bundle branch block simulated with atarioventricular sequential pacing. American Journal of Cardiology, 53, 99–104.

    Article  PubMed  CAS  Google Scholar 

  2. Saxon, L. A., Stevenson, W. G., Middlekauff, H. R., & Stevenson, L. W. (1993). Increased risk of progressive hemodynamic deterioration in advanced heart failure patients requiring permanent pacemakers. American Heart Journal, 125, 1306–1310.

    Article  PubMed  CAS  Google Scholar 

  3. Wilkoff, B. L., Cook, J. R., Epstein, A. E., et al. (2002). Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. Journal of the American Medical Association, 288, 3115–3123.

    Article  PubMed  Google Scholar 

  4. Kavanaugh, K. M., Belenkie, I., & Duff, H. J. (2008). Transmural temporospatial left ventricular activation during pacing from different sites: Potential implications for optimal pacing. Cardiovascular Research, 77, 81–88.

    Article  CAS  Google Scholar 

  5. Giudici, M. C., Barold, S. S., Paul, D. L., Schrumpf, P. E., Van Why, K. J., & Orias, D. W. (2004). Right ventricular outflow tract placement of defibrillation leads: Five year experience. Pacing and Clinical Electrophysiology, 27, 443–446.

    Article  PubMed  Google Scholar 

  6. Gold, M. R., Higgins, S., Klein, R., et al. (2002). Efficacy and temporal stability of reduced safety margins for ventricular defibrillation: Primary results from the Low Energy Safety Study (LESS). Circulation, 105, 2043–2048.

    Article  PubMed  Google Scholar 

  7. Lubinski, A., Lewicka-Nowak, E., Krolak, T., et al. (2000). Implantation and follow-up of ICD leads implanted in the right ventricular outflow tract. Pacing and Clinical Electrophysiology, 23, 1996–1998.

    PubMed  CAS  Google Scholar 

  8. Shorofsky, S. R., Peters, R. W., Rashba, E. J., & Gold, M. R. (2004). Comparison of step-down and binary search algorithms for determination of defibrillation threshold in humans. Pacing and Clinical Electrophysiology, 27, 218–220.

    Article  PubMed  Google Scholar 

  9. Zipes, D. P., Fisher, J., King, R. M., Nicoll, A. debB., & Jolly, W. W. (1975). Termination of ventricular fibrillation in dogs by depolarizing a critical amount of myocardium. American Journal of Cardiology, 36, 37–44.

    Article  PubMed  CAS  Google Scholar 

  10. Singer, I., & Lang, D. (1992). Defibrillation threshold: Clinical utility and therapeutic implications. Pacing and Clinical Electrophysiology, 15, 932–949.

    Article  PubMed  CAS  Google Scholar 

  11. Schuder, J. C., Stoeckle, M. D., & Dolan, A. M. (1964). Transthoracic ventricular defibrillation and square-wave stimuli, one-half cycle, one cycle, and multicycle waveforms. Circulation Research, 15, 258–264.

    PubMed  CAS  Google Scholar 

  12. Jones, D. L., Irish, W. D., & Klein, G. J. (1991). Defibrillation efficacy. Comparison of defibrillation threshold versus dose–response curve determination. Circulation Research, 69, 45–51.

    PubMed  CAS  Google Scholar 

  13. Strickberger, S. A., Daoud, E. G., Davidson, T., et al. (1997). Probability of successful defibrillation at multiples of the defibrillation energy requirement in patients with an implantable defibrillator. Circulation, 96, 1217–1223.

    PubMed  CAS  Google Scholar 

  14. Schwartzman, D., Concato, J., Ren, J.-F., et al. (1996). Factors associated with successful implantation of nonthoracotomy defibrillation lead systems. American Heart Journal, 131, 1127–1136.

    Article  PubMed  CAS  Google Scholar 

  15. Shukla, H. H., Flaker, G. C., Jayam, V., & Roberts, D. (2003). High defibrillation thresholds in transvenous biphasic implatable defibrillators: Clinical predictors and prognostic implications. Pacing and Clinical Electrophysiology, 26, 44–48.

    Article  PubMed  Google Scholar 

  16. Pinski, S. L., Vanerio, G., Castle, L. W., et al. (1991). Patients with a high defibrillation threshold: Clinical characteristics, management, and outcome. American Heart Journal, 122, 89–95.

    Article  PubMed  CAS  Google Scholar 

  17. Hohnloser, S. H., Dorian, P., Roberts, R., et al. (2006). Effect of amiodarone and sotalol on ventricular defibrillation threshold: The optimal pharmacological therapy in cardioverter defibrillator patients (OPTIC) trial. Circulation, 114, 104–109.

    Article  PubMed  CAS  Google Scholar 

  18. Epstein, A. E., Ellenbogen, K. A., Kirk, K. A., Kay, G. N., Dailey, S. M., & Plumb, V. J. (1992). Clinical characteristics and outcome of patients with high defibrillation thresholds. A multicenter study. Circulation, 86, 1206–1216.

    PubMed  CAS  Google Scholar 

  19. Leong-Sit, P., Gula, L. J., Diamantouros, P., et al. (2006). Effect of defibrillation testing on management during implantable cardioverter–defibrillator implantation. American Heart Journal, 152, 1104–1108.

    Article  PubMed  Google Scholar 

  20. Natale, A., Sra, J., Axtell, K., et al. (1994). Preliminary experience with a hybrid nonthoracotomy defibrillating system that includes a biphasic device: Comparison with a standard monophasic device using the same lead system. Journal of the American College of Cardiology, 24, 406–412.

    Article  PubMed  CAS  Google Scholar 

  21. Schwartzman, D., Callans, D. J., Gottlieb, C. D., Heo, J., & Marchlinski, F. E. (1996). Early postoperative rise in defibrillation threshold in patients with nonthoracotomy defibrillation lead systems: Attenuation with biphasic shock waveforms. Journal of Cardiovascular Electrophysiology, 7, 483–493.

    Article  PubMed  CAS  Google Scholar 

  22. Strickberger, S. A., Ching Man, K., Daoud, E., et al. (1995). Effect of first-phase polarity of biphasic shocks on defibrillation threshold with a single transvenous lead system. Journal of the American College of Cardiology, 25, 1605–1608.

    Article  PubMed  CAS  Google Scholar 

  23. Olsovsky, M. R., Shorofsky, S. R., & Gold, M. R. (1998). Effect of shock polarity on biphasic defibrillation thresholds using an active pectoral lead system. Journal of Cardiovascular Electrophysiology, 9, 350–354.

    Article  PubMed  CAS  Google Scholar 

  24. Schauerte, P., Stellbrink, C., Schöndube, F. A., et al. (1997). Polarity reversal improves defibrillation efficacy in patients undergoing transvenous cardioverter defibrillator implantation with biphasic shocks. Pacing and Clinical Electrophysiology, 20, 301–306.

    Article  PubMed  CAS  Google Scholar 

  25. Manolis, A. S., Chiladakis, J., Maounis, T. N., Vassilikos, V., & Cokkinos, D. V. (2000). Two-coil versus single-coil transvenous cardioverter–defibrillator systems: Comparative data. Pacing and Clinical Electrophysiology, 23, 1999–2002.

    Article  PubMed  CAS  Google Scholar 

  26. Rinaldi, C. A., Simon, R. D., Geelen, P., et al. (2003). A randomized prospective study of single coil versus dual coil defibrillation in patients with ventricular arrhythmias undergoing implantable cardioverter defibrillator therapy. Pacing and Clinical Electrophysiology, 26, 1684–1690.

    Article  PubMed  Google Scholar 

  27. Rashba, E. J., Bonner, M., Wilson, J., Shorofsky, S. R., Peters, R. W., & Gold, M. R. (2003). Distal right ventricular coil position reduces defibrillation thresholds. Journal of Cardiovascular Electrophysiology, 14, 1036–1040.

    Article  PubMed  Google Scholar 

  28. Winter, J., Zimmerman, N., Lidolt, H., et al. (2000). Optimal method to achieve consistently low defibrillation energy requirements. American Journal of Cardiology, 86(9A), 71K–75K.

    Article  PubMed  CAS  Google Scholar 

  29. Friedman, P. A., Rasmussen, M. J., Grice, S., Trusty, J., Glikson, M., & Stanton, M. S. (1999). Defibrillation thresholds are increased by right-sided implantation of totally transvenous implantable cardioverter defibrillators. Pacing and Clinical Electrophysiology, 22, 1186–1192.

    Article  PubMed  CAS  Google Scholar 

  30. Almquist, A. K., Montgomery, J. V., Haas, T. S., & Maron, B. J. (2005). Cardioverter–defibrillator implantation in high-risk patients with hypertrophic cardiomyopathy. Heart Rhythm, 2, 814–819.

    Article  PubMed  Google Scholar 

  31. Tang, A. S., Hendry, P., Goldstein, W., Green, M. S., & Luge, M. (1996). Nonthoracotomy implantation of cardioverter defibrillators: Preliminary experience with a defibrillation lead placed at the right ventricular outflow tract. Pacing and Clinical Electrophysiology, 19, 960–964.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This study was funded by the Duluth Clinic Foundation.

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Authors and Affiliations

  1. St. Mary’s/Duluth Clinic, 407 East 3rd Street, Duluth, MN, 55805, USA

    Michael Mollerus & Margaret Lipinski

  2. Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Thomas Munger

Authors
  1. Michael Mollerus
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  2. Margaret Lipinski
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  3. Thomas Munger
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Correspondence to Michael Mollerus.

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Mollerus, M., Lipinski, M. & Munger, T. A randomized comparison of defibrillation thresholds in the right ventricular outflow tract versus right ventricular apex. J Interv Card Electrophysiol 22, 221–225 (2008). https://doi.org/10.1007/s10840-008-9254-x

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  • DOI: https://doi.org/10.1007/s10840-008-9254-x

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