open access

Vol 63, No 9 (2005)
Other
Published online: 2005-09-21
Submitted: 2012-12-28
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ORIGINAL ARTICLE
Comparison of defibrillation efficacy using implantable cardioverter-defibrillator with single- or dual-coil defibrillation leads and active can

Andrzej Lubiński, Ewa Lewicka-Nowak, Agnieszka Zienciuk, Tomasz Królak, Maciej Kempa, Anna Pazdyga, Grzegorz Raczak, Grażyna Świątecka
Kardiol Pol 2005;63(9):234-241.

open access

Vol 63, No 9 (2005)
Other
Published online: 2005-09-21
Submitted: 2012-12-28

Abstract

Introduction: The reduction of defibrillation threshold (DFT) in patients treated with an implantable cardioverter-defibrillator increases patients\' safety and prolongs ICD battery life. Aim: To evaluate the possibility of reducing the defibrillation threshold in ICDs with an active can and an additional atrial defibrillation coil instead of the typical intracardiac single-coil lead. Method: This study involved 138 patients (36 F and 102 M, mean age 54±15 years) including 62 subjects with dual-coil defibrillation lead (group A) and 76 ones with single-coil defibrillation lead (group B). No statistically significant differences with respect to age, left ventricular function, main disease or exacerbation of heart failure according to the NYHA functional class were observed between groups. The defibrillation threshold was measured using the DFT+ protocol. Results: No significant differences between groups were identified with respect to pacing and sensing parameters. The comparison of DFT values between the two studied groups revealed significant improvement (by 14% mean) of defibrillation efficacy in group A. In group A, the mean DFT was 9.8±4.6 J (3-20 J) and mean defibrillation resistance – 45±7 W (32-73 W), whereas in group B: 11.45±5.25 J (3-28 J) and 72±12.8 W (38-106 W), respectively. In 93% of patients from group A, DFT was below 15 J, in comparison to 81% of patients from group B (p=0.046). The odds ratio of a higher defibrillation threshold (ł15 J) in group A vs. group B was 0.3 (95% confidence interval: 0.09-0.98). The DFT reduction associated with modified ICD system use was independent of following clinical parameters: patient age, gender, main disease, end-diastolic left ventricular diameter, left ventricular ejection fraction, NYHA functional class and concomitant treatment with antiarrhythmic agents. Conclusions: Modification of the electric field during defibrillation, achieved with the use of active-can ICDs with dual-coil defibrillation leads, allows a reduction of DFT by 14%. At the same time, it reduces the risk of a higher (≥15 J) DFT by three times compared to patients with a standard single-coil defibrillation lead.

Abstract

Introduction: The reduction of defibrillation threshold (DFT) in patients treated with an implantable cardioverter-defibrillator increases patients\' safety and prolongs ICD battery life. Aim: To evaluate the possibility of reducing the defibrillation threshold in ICDs with an active can and an additional atrial defibrillation coil instead of the typical intracardiac single-coil lead. Method: This study involved 138 patients (36 F and 102 M, mean age 54±15 years) including 62 subjects with dual-coil defibrillation lead (group A) and 76 ones with single-coil defibrillation lead (group B). No statistically significant differences with respect to age, left ventricular function, main disease or exacerbation of heart failure according to the NYHA functional class were observed between groups. The defibrillation threshold was measured using the DFT+ protocol. Results: No significant differences between groups were identified with respect to pacing and sensing parameters. The comparison of DFT values between the two studied groups revealed significant improvement (by 14% mean) of defibrillation efficacy in group A. In group A, the mean DFT was 9.8±4.6 J (3-20 J) and mean defibrillation resistance – 45±7 W (32-73 W), whereas in group B: 11.45±5.25 J (3-28 J) and 72±12.8 W (38-106 W), respectively. In 93% of patients from group A, DFT was below 15 J, in comparison to 81% of patients from group B (p=0.046). The odds ratio of a higher defibrillation threshold (ł15 J) in group A vs. group B was 0.3 (95% confidence interval: 0.09-0.98). The DFT reduction associated with modified ICD system use was independent of following clinical parameters: patient age, gender, main disease, end-diastolic left ventricular diameter, left ventricular ejection fraction, NYHA functional class and concomitant treatment with antiarrhythmic agents. Conclusions: Modification of the electric field during defibrillation, achieved with the use of active-can ICDs with dual-coil defibrillation leads, allows a reduction of DFT by 14%. At the same time, it reduces the risk of a higher (≥15 J) DFT by three times compared to patients with a standard single-coil defibrillation lead.
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Keywords

implantable cardioverter-defibrillator; defibrillation threshold; two-coil and single-coil transvenous cardioverter defibrillator systems

About this article
Title

ORIGINAL ARTICLE
Comparison of defibrillation efficacy using implantable cardioverter-defibrillator with single- or dual-coil defibrillation leads and active can

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 63, No 9 (2005)

Pages

234-241

Published online

2005-09-21

Bibliographic record

Kardiol Pol 2005;63(9):234-241.

Keywords

implantable cardioverter-defibrillator
defibrillation threshold
two-coil and single-coil transvenous cardioverter defibrillator systems

Authors

Andrzej Lubiński
Ewa Lewicka-Nowak
Agnieszka Zienciuk
Tomasz Królak
Maciej Kempa
Anna Pazdyga
Grzegorz Raczak
Grażyna Świątecka

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