PRELIMINARY EXPERIENCE WITH A HYBRID NONTHORACOTOMY DEFIBRILLATING SYSTEM THAT INCLUDES A BIPHASIC DEVICE - COMPARISON WITH A STANDARD MONOPHASIC DEVICE USING THE SAME LEAD SYSTEM

Objectives. This study analyzed the advantage of combining a biphasic device with a transvenous system and compared the results with those obtained with a standard monophasic device. Background. Available lead systems use monophasic pulses and may require lengthy intraoperative testing to achieve adequate defibrillation threshold in a conspicuous number of patients. The option of biphasic waveform may provide further benefits. However, clinical experience with a permanent implant is lacking. Methods. Fifty five patients underwent testing and received a permanent implant using the Endotak lead system associated with a CPI monophasic device. The remaining 36 patients received a permanent implant with the Endotak lead system connected to a biphasic device. In both groups a subcutaneous patch was com bined when needed to obtain acceptable defibrillation thresholds. Results. Biphasic pulses resulted in lower mean (+/-SD) defibril lation thresholds (monophasic 15 +/- 4.7 J vs. biphasic 12 +/- 5 J, p = 0.03) and a better implantation rate (100% biphasic vs. 89% monophasic, p = 0.07), Biphasic pulses allowed implantation with less ventricular fibrillation induction (7.4 +/- 3.2 vs. 3.5 +/- 1.8, p < 0.01) and a mean shorter procedure time (168 +/- 39 vs. 111 +/- 30 min, p < 0.01). With the biphasic waveform a greater proportion of patients met the implantation criteria with the lead system alone (83% vs. 45%, p < 0.01). When needed, the left prepectoral location of the patch electrode was always sufficient in patients receiving the biphasic device, whereas placement in the left subscapular position was required in 15 patients in the monophasic group. Implantation of the biphasic device was associated with a shorter mean hospital stay (3.8 +/- 0.8 vs. 5.4 +/- 2.2 days, p < 0.01). Conclusions. Incorporation of a biphasic device in a trans- venous implantable cardioverter defibrillator uniformly increases the efficacy of the system and the ease of implantation.