Optimal electrode position for transvenous defibrillation: A prospective randomized study

Karl C. Stajduhar, Gary Y. Ott, Jack Kron, John H. McAnulty, Ronald P. Oliver, Brian T. Reynolds, Stuart W. Adler, Blair D. Halperin

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objectives. This study was performed to determine the optimal position for the proximal electrode in a two-electrode transvenous defibrillation system. Background. Minimizing the energy required to defibrillate the heart has several potential advantages. Despite the increased use of two electrode transvenous defibrillation systems, the optimal position for the proximal electrode has not been systematically evaluated. Methods. Defibrillation thresholds were determined twice in random sequence in 16 patients undergoing implantation of a two-lead transvenous defibrillation system; once with the proximal electrode at the right atrial-superior vena cava junction (superior vena cava position) and once with the proximal electrode in the left subclavian-innominate vein (innominate vein position). Results. The mean (±SD) defibrillation threshold with the proximal electrode in the innominate vein position was significantly lower than with the electrode in the superior vena cava position (13.4 ± 5.7 J vs. 16.3 ± 6.6 J, p = 0.04). Defibrillation threshold with the proximal electrode in the innominate vein position was lower or equal to that achieved in the superior vena cava position in 75% of patients. In patients with normal heart size (cardiothoracic ratio ≤0.55), the improvement in defibrillation threshold with the proximal electrode in the innominate vein position was more significant than in patients with an enlarged heart (innominate vein 13.0 ± 6.5 J vs. superior vena cava 17.9 ± 5.1 J, p <0.01). In patients with an enlarged heart, no difference between the two sites was observed (innominate vein 13.9 ± 4.5 J vs. superior vena cava 13.6 ± 8.3 J, p = NS). Conclusions. During implantation of a two-lead transvenous defibrillation system, positioning the proximal defibrillation electrode in the subclavian-innominate vein will lower defibrillation energy requirements in the majority of patients.

Original languageEnglish (US)
Pages (from-to)90-94
Number of pages5
JournalJournal of the American College of Cardiology
Volume27
Issue number1
DOIs
StatePublished - Jan 1996

Fingerprint

Brachiocephalic Veins
Electrodes
Prospective Studies
Superior Vena Cava
Subclavian Vein
Cardiomegaly

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Stajduhar, K. C., Ott, G. Y., Kron, J., McAnulty, J. H., Oliver, R. P., Reynolds, B. T., ... Halperin, B. D. (1996). Optimal electrode position for transvenous defibrillation: A prospective randomized study. Journal of the American College of Cardiology, 27(1), 90-94. https://doi.org/10.1016/0735-1097(95)00380-0

Optimal electrode position for transvenous defibrillation : A prospective randomized study. / Stajduhar, Karl C.; Ott, Gary Y.; Kron, Jack; McAnulty, John H.; Oliver, Ronald P.; Reynolds, Brian T.; Adler, Stuart W.; Halperin, Blair D.

In: Journal of the American College of Cardiology, Vol. 27, No. 1, 01.1996, p. 90-94.

Research output: Contribution to journalArticle

Stajduhar, KC, Ott, GY, Kron, J, McAnulty, JH, Oliver, RP, Reynolds, BT, Adler, SW & Halperin, BD 1996, 'Optimal electrode position for transvenous defibrillation: A prospective randomized study', Journal of the American College of Cardiology, vol. 27, no. 1, pp. 90-94. https://doi.org/10.1016/0735-1097(95)00380-0
Stajduhar, Karl C. ; Ott, Gary Y. ; Kron, Jack ; McAnulty, John H. ; Oliver, Ronald P. ; Reynolds, Brian T. ; Adler, Stuart W. ; Halperin, Blair D. / Optimal electrode position for transvenous defibrillation : A prospective randomized study. In: Journal of the American College of Cardiology. 1996 ; Vol. 27, No. 1. pp. 90-94.
@article{b04c1824bc7b40739bfee1c25b23d26d,
title = "Optimal electrode position for transvenous defibrillation: A prospective randomized study",
abstract = "Objectives. This study was performed to determine the optimal position for the proximal electrode in a two-electrode transvenous defibrillation system. Background. Minimizing the energy required to defibrillate the heart has several potential advantages. Despite the increased use of two electrode transvenous defibrillation systems, the optimal position for the proximal electrode has not been systematically evaluated. Methods. Defibrillation thresholds were determined twice in random sequence in 16 patients undergoing implantation of a two-lead transvenous defibrillation system; once with the proximal electrode at the right atrial-superior vena cava junction (superior vena cava position) and once with the proximal electrode in the left subclavian-innominate vein (innominate vein position). Results. The mean (±SD) defibrillation threshold with the proximal electrode in the innominate vein position was significantly lower than with the electrode in the superior vena cava position (13.4 ± 5.7 J vs. 16.3 ± 6.6 J, p = 0.04). Defibrillation threshold with the proximal electrode in the innominate vein position was lower or equal to that achieved in the superior vena cava position in 75{\%} of patients. In patients with normal heart size (cardiothoracic ratio ≤0.55), the improvement in defibrillation threshold with the proximal electrode in the innominate vein position was more significant than in patients with an enlarged heart (innominate vein 13.0 ± 6.5 J vs. superior vena cava 17.9 ± 5.1 J, p <0.01). In patients with an enlarged heart, no difference between the two sites was observed (innominate vein 13.9 ± 4.5 J vs. superior vena cava 13.6 ± 8.3 J, p = NS). Conclusions. During implantation of a two-lead transvenous defibrillation system, positioning the proximal defibrillation electrode in the subclavian-innominate vein will lower defibrillation energy requirements in the majority of patients.",
author = "Stajduhar, {Karl C.} and Ott, {Gary Y.} and Jack Kron and McAnulty, {John H.} and Oliver, {Ronald P.} and Reynolds, {Brian T.} and Adler, {Stuart W.} and Halperin, {Blair D.}",
year = "1996",
month = "1",
doi = "10.1016/0735-1097(95)00380-0",
language = "English (US)",
volume = "27",
pages = "90--94",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Optimal electrode position for transvenous defibrillation

T2 - A prospective randomized study

AU - Stajduhar, Karl C.

AU - Ott, Gary Y.

AU - Kron, Jack

AU - McAnulty, John H.

AU - Oliver, Ronald P.

AU - Reynolds, Brian T.

AU - Adler, Stuart W.

AU - Halperin, Blair D.

PY - 1996/1

Y1 - 1996/1

N2 - Objectives. This study was performed to determine the optimal position for the proximal electrode in a two-electrode transvenous defibrillation system. Background. Minimizing the energy required to defibrillate the heart has several potential advantages. Despite the increased use of two electrode transvenous defibrillation systems, the optimal position for the proximal electrode has not been systematically evaluated. Methods. Defibrillation thresholds were determined twice in random sequence in 16 patients undergoing implantation of a two-lead transvenous defibrillation system; once with the proximal electrode at the right atrial-superior vena cava junction (superior vena cava position) and once with the proximal electrode in the left subclavian-innominate vein (innominate vein position). Results. The mean (±SD) defibrillation threshold with the proximal electrode in the innominate vein position was significantly lower than with the electrode in the superior vena cava position (13.4 ± 5.7 J vs. 16.3 ± 6.6 J, p = 0.04). Defibrillation threshold with the proximal electrode in the innominate vein position was lower or equal to that achieved in the superior vena cava position in 75% of patients. In patients with normal heart size (cardiothoracic ratio ≤0.55), the improvement in defibrillation threshold with the proximal electrode in the innominate vein position was more significant than in patients with an enlarged heart (innominate vein 13.0 ± 6.5 J vs. superior vena cava 17.9 ± 5.1 J, p <0.01). In patients with an enlarged heart, no difference between the two sites was observed (innominate vein 13.9 ± 4.5 J vs. superior vena cava 13.6 ± 8.3 J, p = NS). Conclusions. During implantation of a two-lead transvenous defibrillation system, positioning the proximal defibrillation electrode in the subclavian-innominate vein will lower defibrillation energy requirements in the majority of patients.

AB - Objectives. This study was performed to determine the optimal position for the proximal electrode in a two-electrode transvenous defibrillation system. Background. Minimizing the energy required to defibrillate the heart has several potential advantages. Despite the increased use of two electrode transvenous defibrillation systems, the optimal position for the proximal electrode has not been systematically evaluated. Methods. Defibrillation thresholds were determined twice in random sequence in 16 patients undergoing implantation of a two-lead transvenous defibrillation system; once with the proximal electrode at the right atrial-superior vena cava junction (superior vena cava position) and once with the proximal electrode in the left subclavian-innominate vein (innominate vein position). Results. The mean (±SD) defibrillation threshold with the proximal electrode in the innominate vein position was significantly lower than with the electrode in the superior vena cava position (13.4 ± 5.7 J vs. 16.3 ± 6.6 J, p = 0.04). Defibrillation threshold with the proximal electrode in the innominate vein position was lower or equal to that achieved in the superior vena cava position in 75% of patients. In patients with normal heart size (cardiothoracic ratio ≤0.55), the improvement in defibrillation threshold with the proximal electrode in the innominate vein position was more significant than in patients with an enlarged heart (innominate vein 13.0 ± 6.5 J vs. superior vena cava 17.9 ± 5.1 J, p <0.01). In patients with an enlarged heart, no difference between the two sites was observed (innominate vein 13.9 ± 4.5 J vs. superior vena cava 13.6 ± 8.3 J, p = NS). Conclusions. During implantation of a two-lead transvenous defibrillation system, positioning the proximal defibrillation electrode in the subclavian-innominate vein will lower defibrillation energy requirements in the majority of patients.

UR - http://www.scopus.com/inward/record.url?scp=0030069008&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030069008&partnerID=8YFLogxK

U2 - 10.1016/0735-1097(95)00380-0

DO - 10.1016/0735-1097(95)00380-0

M3 - Article

C2 - 8522716

AN - SCOPUS:0030069008

VL - 27

SP - 90

EP - 94

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 1

ER -