EFFECTS OF INITIAL POLARITY ON DEFIBRILLATION THRESHOLD WITH BIPHASIC PULSES

被引:27
作者
NATALE, A
SRA, T
DHALA, A
JAZAYERI, M
DESHPANDE, S
AXTELL, K
AKHTAR, M
机构
[1] SINAI SAMARITAN MED CTR,MILWAUKEE HEART INST,ELECTROPHYSIOL LAB,MILWAUKEE,WI
[2] UNIV WISCONSIN,ST LUKES MED CTR,MILWAUKEE,WI 53201
来源
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY | 1995年 / 18卷 / 10期
关键词
DEFIBRILLATION; TRANSVENOUS SYSTEM; POLARITY; BIPHASIC SHOCKS;
D O I
10.1111/j.1540-8159.1995.tb03837.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Previous studies have shown that the polarity of epicardial patches significantly affects the defibrillation efficacy of monophasic shocks. However, whether this improvement can be extended to different using methods and lead systems, such as biphasic shocks using endocardial defibrillating electrodes, is unknown. Methods: Twenty consecutive patients undergoing testing and permanent implant using an Endotak lead system with a biphasic device were included in the study in each patient the defibrillation thresh old was determined delivering biphasic pulses with the distal coil as the cathode and the proximal coil as the anode during the positive phase and with the polarity reversed. The initial electrode polarity tested was chosen randomly. The defibrillation threshold was defined as the lowest pulse amplitude that effectively terminated ventricular fibrillation induced with 60-Hz alternating current. For each biphasic pulse peak voltage, pulse duration, resistance, and stored energy were recorded. Results: Of the 20 patients, 12 (60%) had lower defibrillation threshold when the proximal coil was negative, whereas only 2 patients had a lower defibrillation thresh old when the distal coil wets negative. In four patients a subcutaneous patch would have been required if only the biphasic pulse with the distal coil as negative had been tested. The mean stored defibrillation threshold energy was lower with the configuration using the proximal coil as cathode (16.3 +/- 8.8 J vs 21.5 +/- 11 J; P < 0.01). Conclusion: Change in the initial polarity of biphasic shocks may influence defibrillation efficacy and should, therefore, be assessed in each patient to achieve a more satisfactory safety margin and minimize the use of more invasive lead configurations.
引用
收藏
页码:1889 / 1893
页数:5
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