Reduction in defibrillation threshold using an auxiliary shock delivered in the middle cardiac vein

Defibrillation in the middle cardiac vein (MCV has been shown to reduce ventricular defibrillation thresh olds (DFTs). Low amplitude auxiliary shock (AS) from an electrode sutured to the left ventricle at thoracotomy have also been shown to reduce DFT if delivered immediately prior to a biphasic shock (between the ventricular RV and superior vena caval (SVC) electrodes). This study investigates the impact on DFT of an AS shock from a transvenously placed MCV lead system, A standard defibrillation electrode was positioned in the RV in eight anesthetized pigs (35-43 kg), A 50 x 1.8-mm electrode was inserted in the MCV through an 8 Fr angioplasty guide catheter. A 150-V(leading edge) monophasic AS was delivered (95 mu F capacitor) from the MCV --> Can with three different pulse widths (3, 5, 7 ms). A primary biphasic shock (PS) (95 mu F capacitor, phase1:44 % tilt, 1,6-ms extension and phase 2:2.5-ms fixed duration) was delivered from the RV 7 --> Can +/- AS. The four configurations were randomized and DFTs (PS + AS) assessed using a modified binary search. Ventricular fibrillation (VF) nas induced with 60 Hz AC followed 10 seconds later by the test shock. The DFTs were compared using repeated measures analysis of variance (ANOVA). All configurations incorporating AS produced significant (P < 0.05) reduction in the DFT compared to no AS (13.8 +/- 7.4 J). There was no difference in the efficacy of differing pulse widths (P > 0.05); 3 ms (11.0 +/- 5.4 J), 5 ms (11.5 +/- 6.0), and 7 ms (10.6 +/- 5.3 J), In conclusion, delivering an AS from a transvenous lead system deployed in the MCV reduces the DFT by 23 % compared to a conventional RV --> Can shock alone.