USE OF MULTIPLE PATCHES DURING IMPLANTATION OF EPICARDIAL DEFIBRILLATOR SYSTEMS

被引:9
作者
BAERMAN, JM [1 ]
BLAKEMAN, BP [1 ]
OLSHANSKY, B [1 ]
KOPP, DE [1 ]
KALL, JG [1 ]
WILBER, DJ [1 ]
机构
[1] LOYOLA UNIV,MED CTR,DEPT THORAC CARDIOVASC SURG,MAYWOOD,IL 60153
关键词
D O I
10.1016/0002-9149(93)90712-L
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
During implantation of epicardial automatic defibrillator systems, occasional patients have difficulty in obtaining adequate defibrillation thresholds. Of 236 consecutive patients undergoing implantation of epicardial defibrillator systems, 18 patients received a 3-patch (n = 15) or 4-patch (n = 3) defibrillator system. Twelve patients who received a multiple-patch defibrillator system had a best 2-patch defibrillation energy requirement of greater-than-or-equal-to 30 J; in the remaining 6 patients less stringent clinical criteria were used in the decision to add a third defibrillator patch (defibrillation energy requirement >18 J in 4 patients, and >20 J in 2 patients). Technically, multiple-patch systems were made possible with either the use of Y-connectors or defibrillators allowing output to 3 patches. In 3 patients, addition of third epicardial patch still resulted in a defibrillation energy requirement of greater-than-or-equal-to 30 J; in these 3 patients, addition of a fourth patch resulted in a defibrillation energy requirement of less-than-or-equal-to 20 J. All patients receiving a multiple-patch defibrillator system had a reduction in defibrillation energy requirement, and 12 patients had a reduction in defibrillation energy requirement of greater-than-or-equal-to 10 J over the best 2-patch defibrillation energy requirement. In the patients who eventually had placement of a multiple-patch system, the best 2-patch defibrillation energy requirement was >18 J in 4 patients, >20 J in 2 patients, greater-than-or-equal-to 30 J in 9 patients, and >40 in 3 patients. After placement of a multiple-patch system, the defibrillation energy requirement was less-than-or-equal-to 24 J in 1 patient, less-than-or-equal-to 20 in 5 patients, less-than-or-equal-to 18 J in 8 patients, less-than-or-equal-to 15 J in 2 patients and less-than-or-equal-to 10 J in 2 patients. This improvement was significant (p<0.005). During implantable defibrillator placement associated with a high defibrillation energy requirement with a 2-patch system, placement of a 3- or 4-patch system may result in a marked improvement in defibrillation energy requirement.
引用
收藏
页码:68 / 71
页数:4
相关论文
共 23 条
  • [1] CONSTRICTIVE PERICARDITIS ASSOCIATED WITH PATCH ELECTRODES OF THE AUTOMATIC IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
    ALMASSI, GH
    CHAPMAN, PD
    TROUP, PJ
    WETHERBEE, JN
    OLINGER, GN
    [J]. CHEST, 1987, 92 (02) : 369 - 371
  • [2] EVALUATION OF ELECTRODE POLARITY ON DEFIBRILLATION EFFICACY
    BARDY, GH
    IVEY, TD
    ALLEN, MD
    JOHNSON, G
    GREENE, HL
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1989, 63 (07) : 433 - 437
  • [3] PROSPECTIVE COMPARISON OF SEQUENTIAL PULSE AND SINGLE PULSE DEFIBRILLATION WITH USE OF 2 DIFFERENT CLINICALLY AVAILABLE SYSTEMS
    BARDY, GH
    IVEY, TD
    ALLEN, MD
    JOHNSON, G
    GREENE, HL
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 14 (01) : 165 - 171
  • [4] BOURLAND JD, 1986, MED INSTRUM, V20, P138
  • [5] DOUBLE AND TRIPLE SEQUENTIAL SHOCKS REDUCE VENTRICULAR DEFIBRILLATION THRESHOLD IN DOGS WITH AND WITHOUT MYOCARDIAL-INFARCTION
    CHANG, MS
    INOUE, H
    KALLOK, MJ
    ZIPES, DP
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1986, 8 (06) : 1393 - 1405
  • [6] COMPARATIVE EFFICACY OF MONOPHASIC AND BIPHASIC TRUNCATED EXPONENTIAL SHOCKS FOR NONTHORACOTOMY INTERNAL DEFIBRILLATION IN DOGS
    CHAPMAN, PD
    VETTER, JW
    SOUZA, JJ
    TROUP, PJ
    WETHERBEE, JN
    HOFFMANN, RG
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1988, 12 (03) : 739 - 745
  • [7] COMPARISON OF MONOPHASIC WITH SINGLE AND DUAL CAPACITOR BIPHASIC WAVEFORMS FOR NONTHORACOTOMY CANINE INTERNAL DEFIBRILLATION
    CHAPMAN, PD
    VETTER, JW
    SOUZA, JJ
    WETHERBEE, JN
    TROUP, PJ
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 14 (01) : 242 - 245
  • [8] IMPROVED DEFIBRILLATION THRESHOLDS WITH LARGE CONTOURED EPICARDIAL ELECTRODES AND BIPHASIC WAVE-FORMS
    DIXON, EG
    TANG, ASL
    WOLF, PD
    MEADOR, JT
    FINE, MJ
    CALFEE, RV
    IDEKER, RE
    [J]. CIRCULATION, 1987, 76 (05) : 1176 - 1184
  • [9] CLINICAL-EXPERIENCE, COMPLICATIONS, AND SURVIVAL IN 70 PATIENTS WITH THE AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR
    ECHT, DS
    ARMSTRONG, K
    SCHMIDT, P
    OYER, PE
    STINSON, EB
    WINKLE, RA
    [J]. CIRCULATION, 1985, 71 (02) : 289 - 296
  • [10] CURRENT CONCEPTS FOR SELECTING THE LOCATION, SIZE AND SHAPE OF DEFIBRILLATION ELECTRODES
    IDEKER, RE
    WOLF, PD
    ALFERNESS, C
    KRASSOWSKA, W
    SMITH, WM
    [J]. PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1991, 14 (02): : 227 - &