Joseph Y S Chan1, Jacek Lelakowski2, Francis D Murgatroyd3, Lucas V Boersma4, Jian Cao5, Vladimir Nikolski5, Griet Wouters6, Mark C S Hall7. 1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Hong Kong. Electronic address: drjyschan@gmail.com. 2. Department of Electrocardiology, The John Paul II Hospital, Krakow, Poland. 3. Department of Cardiology, King's College Hospital, London, United Kingdom. 4. Cardiology Department, St. Antonius Hospital, Nieuwegein, the Netherlands. 5. Cardiac Rhythm and Heart Failure, Medtronic Inc., Mounds View, Minnesota. 6. Cardiac Rhythm and Heart Failure, Medtronic Inc., Maastricht, the Netherlands. 7. Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Abstract
OBJECTIVES: This study assessed the defibrillation efficacy of the substernal-lateral electrode configuration. BACKGROUND: Subcutaneous implantable cardioverter-defibrillators (ICDs) are regarded as alternatives to transvenous ICDs in certain subjects. However, substantially higher shock energy of up to 80 J may be required. Proposed is a new defibrillation method of placing the shock coil into the substernal space. METHODS: This prospective, nonrandomized, feasibility study was conducted in subjects scheduled for midline sternotomy or implant of ICD. A blunted end tunneling tool was used to insert a defibrillation lead behind the sternum using a percutaneous subxiphoid approach. A skin patch electrode was placed on the left mid-axillary line at the fourth to fifth intercostal space. After ventricular fibrillation induction, a single 35-J shock was delivered between the lead and skin patch. RESULTS: Sixteen subjects (12 males, 4 females; mean age: 61.6 ± 11.8 years) were enrolled. The mean lead placement time was 11.1 ± 6.6 min. Of the 14 subjects with successfully induced ventricular fibrillation episodes, 13 subjects (92.9%) had successful defibrillation. The 1 failure was associated with high and lateral shock coil placement. Mean ventricular fibrillation duration was 18.4 ± 5.6 s with a shock impedance of 98.1 ± 19.3 ohms. Of the 11 subjects with coil-patch electrograms, the average R-wave amplitude during sinus rhythm was 3.0 ± 1.4 mV. CONCLUSIONS: These preliminary data demonstrate that substernal defibrillation is feasible and successful defibrillation can be achieved with the shock energy available in current transvenous ICDs. This may open new alternatives to extravascular ICD therapy.
OBJECTIVES: This study assessed the defibrillation efficacy of the substernal-lateral electrode configuration. BACKGROUND: Subcutaneous implantable cardioverter-defibrillators (ICDs) are regarded as alternatives to transvenous ICDs in certain subjects. However, substantially higher shock energy of up to 80 J may be required. Proposed is a new defibrillation method of placing the shock coil into the substernal space. METHODS: This prospective, nonrandomized, feasibility study was conducted in subjects scheduled for midline sternotomy or implant of ICD. A blunted end tunneling tool was used to insert a defibrillation lead behind the sternum using a percutaneous subxiphoid approach. A skin patch electrode was placed on the left mid-axillary line at the fourth to fifth intercostal space. After ventricular fibrillation induction, a single 35-J shock was delivered between the lead and skin patch. RESULTS: Sixteen subjects (12 males, 4 females; mean age: 61.6 ± 11.8 years) were enrolled. The mean lead placement time was 11.1 ± 6.6 min. Of the 14 subjects with successfully induced ventricular fibrillation episodes, 13 subjects (92.9%) had successful defibrillation. The 1 failure was associated with high and lateral shock coil placement. Mean ventricular fibrillation duration was 18.4 ± 5.6 s with a shock impedance of 98.1 ± 19.3 ohms. Of the 11 subjects with coil-patch electrograms, the average R-wave amplitude during sinus rhythm was 3.0 ± 1.4 mV. CONCLUSIONS: These preliminary data demonstrate that substernal defibrillation is feasible and successful defibrillation can be achieved with the shock energy available in current transvenous ICDs. This may open new alternatives to extravascular ICD therapy.
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