The aim of this study was to determine whether defibrillation waveform duration adjustment with single-coil defibrillation leads can be used to increase the proportion of patients with satisfactory defibrillation thresholds (DFTs). A retrospective analysis of the DFT levels for 105 patients with implantable cardioverter-defibrillator devices and a single-coil defibrillation lead was performed. Two groups of patients were compared: 34 patients who had undergone waveform tuning (group A) and 71 patients with a fixed-tilt waveform (group B). Additional data including demographics, etiology, New York Heart Association functional class, left ventricular ejection fraction, high-voltage lead impedance and medications were gathered to determine what effect these variables had on the DFT levels. Of the 34 patients who had undergone waveform adjustment (group A), 27 (79%) were found to have satisfactory DFTs, while 41 (58%) of the 71 patients with fixed-tilt devices (group B) had satisfactory DFTs. Waveform duration adjustment was found to significantly increase the proportion of patients with satisfactory DFTs (p = 0.03).

Keywords:
Defibrillation threshold, Single-coil defibrillation lead, Defibrillation waveform adjustment, Fixed-tilt waveform
1.
Moss A, Hall J, Cannom D, et al: Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 1996;335:1933–1940.
2.
Lee KL, Hafley G, Fisher JD, Gold MR, Prystowsky EN, Talajic M, Josephson ME, Packer DL, Buxton AE, Multicenter Unsustained Tachycardia Trial investigators: Effect of implantable defibrillators on arrhythmic events and mortality in the multicenter unsustained tachycardia trial. Circulation 2002;106:233–238.
3.
A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) investigators. N Engl J Med 1997;337:1576–1583.
4.
Levine E, Rosero SZ, Budzikowski AS, Moss AJ, Zareba W, Daubert JP: Congenital long QT syndrome: considerations for primary care physicians. Cleve Clin J Med 2008;75:591–600.
5.
Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH, the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) investigators: Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225–237.
6.
Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Carrillo RG, Crossley GH 3rd, Epstein LM, Friedman RA, Kennergren CE, Mitkowski P, Schaerf RH, Wazni OM: Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA). Heart Rhythm 2009;6:1085–1104.
7.
Ellenbogen K, Wilkoff B, Kay G, Lau C: Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy, ed 3. Philadelphia, Saunders, 2006.
8.
Rozmus G, Daubert J, Huang D, Rosero S, Hall B, Francis C: Venous thrombosis and stenosis after implantation of pacemakers and defibrillators. J Interv Card Electrophysiol 2005;13:9–19.
9.
Lickfett L, Bitzen A, Arepally A, Nasir K, Wolpert C, Jeong K-M, Krause U, Schimpf R, Lewalter T, Calkins H: Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator. A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement. Europace 2004;6:25–31.
10.
Varma N, Efimov I: Right pectoral implantable cardioverter defibrillators: role of the proximal (SVC) coil. Pacing Clin Electrophysiol 2008;31:1025–1035.
11.
Lubinski A, Lewicka-Nowak E, Zienciuk A, Krolak T, Kempa M, Pazdyga A, Raczak G, Swiatecka G: Comparison of defibrillation efficacy using implantable cardioverter-defibrillator with single- or dual-coil defibrillation leads and active can. Kardiol Pol 2005;63:234–241, discussion 242–243.
12.
Rinaldi CA, Simon RD, Geelen P, Reek S, Baszko A, Kuehl M, Gill JS: A randomized prospective study of single coil versus dual coil defibrillation in patients with ventricular arrhythmias undergoing implantable cardioverter defibrillator therapy. Pacing Clin Electrophysiol 2003;26:1684–1690.
13.
Schulte B, Sperzel J, Carlsson J, Schwarz T, Ehrlich W, Pitschner H, Neuzner J: Dual-coil versus single-coil active pectoral implantable defibrillator lead systems: defibrillation energy requirements and probability of defibrillation success at multiples of the defibrillation energy requirements. Europace 2001;3:177–180.
14.
Gold MR, Olsovsky MR, Pelini MA, Peters RW, Shorofsky SR: Comparison of single- and dual-coil active pectoral defibrillation lead systems. J Am Coll Cardiol 1998;31:1391–1394.
15.
Gold MR, Breiter D, Leman R, Rashba EJ, Shorofsky SR, Hahn SJ: Safety of a single successful conversion of ventricular fibrillation before the implantation of cardioverter defibrillators. Pacing Clin Electrophysiol 2003;26:483–486.
16.
Uyguanco ER, Berger A, Budzikowski AS, Gunsburg M, Kassotis J: Management of high defibrillation threshold. Expert Rev Cardiovasc Ther 2008;6:1237–1248.
17.
Fotuhi PC, Epstein AE, Ideker RE: Energy levels for defibrillation: what is of real clinical importance? Am J Cardiol 1999;83:24D–33D.
18.
Rub N, Schweitzer O, Mewis C, Kettering K, Kuehlkamp V: Addition of a defibrillation electrode in the low right atrium to a right ventricular lead does not reduce ventricular defibrillation thresholds. Pacing Clin Electrophysiol 2004;27:346–351.
19.
Natarajan S, Henthorn R, Burroughs J, Esberg D, Zweibel S, Ross T, Kroll M, Gianola D, Oza A: ‘Tuned’ defibrillation waveforms outperform 50/50% tilt defibrillation waveforms: a randomized multi-center study. Pacing Clin Electrophysiol 2007;30(suppl 1):S139–S142.
20.
Val-Mejias JE, Oza A: Does defibrillation threshold increase as left ventricular ejection fraction decreases? Europace 2010;12:385–388.
21.
Lim H, Flannigan S, Marshall H: Induction by direct current pulse versus 50-Hz pacing on ventricular fibrillation and defibrillation. J Interv Card Electrophysiol 2010;28:209–214.
22.
Denman RA, Umesan C, Martin PT, Forbes RN, Kroll MW, Anskey EJ, Burnett HE: Benefit of millisecond waveform durations for patients with high defibrillation thresholds. Heart Rhythm 2006;3:536–541.
© 2013 S. Karger AG, Basel
2013
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