Single-coil defibrillator leads yield satisfactory defibrillation safety margin in hypertrophic cardiomyopathy

Hideo Okamura, Paul Andrew Friedman, Yuko Inoue, Takashi Noda, Takeshi Aiba, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Kengo Kusano, Raul Emilio Espinosa

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Single-coil defibrillator leads have gained favor because of their potential ease of extraction. However, a high defibrillation threshold remains a concern in patients with hypertrophic cardiomyopathy (HCM), and in many cases, dual-coil leads have been used for this patient group. There is little data on using single-coil leads for HCM patients. Methods and Results: We evaluated 20 patients with HCM who received an implantable cardioverter-defibrillator (ICD) on the left side in combination with a dual-coil lead. Two sets of defibrillation tests were performed in each patient, one with the superior vena cava (SVC) coil “on” and one with the SVC coil “off”. ICDs were programmed to deliver 25 joules (J) for the first attempt followed by maximum energy (35 J or 40 J). Shock impedance and shock pulse width at 25 J in each setting as well as the results of the shock were analyzed. All 25-J shocks in both settings successfully terminated ventricular fibrillation. However, shock impedance and pulse width increased substantially with the SVC coil programmed “off” compared with “on” (66.4±6.1 ohm and 14.0±1.3 ms “off” vs. 41.9±5.0 ohm and 9.3±0.8 ms “on”, P<0.0001 respectively). Conclusions: Biphasic 25-J shocks with the SVC coil ‘off’ successfully terminated ventricular fibrillation in HCM patients, indicating a satisfactory safety margin for 35-J devices. Single-coil leads appear appropriate for left-sided implantation in this patient group.

Original languageEnglish (US)
Pages (from-to)2199-2203
Number of pages5
JournalCirculation Journal
Volume80
Issue number10
DOIs
StatePublished - 2016

Fingerprint

Defibrillators
Hypertrophic Cardiomyopathy
Shock
Superior Vena Cava
Safety
Ventricular Fibrillation
Electric Impedance
Pulse
Implantable Defibrillators
Equipment and Supplies

Keywords

  • Defibrillation threshold
  • Hypertrophic cardiomyopathy
  • Implantable cardioverter-defibrillator
  • Single-coil leads

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Single-coil defibrillator leads yield satisfactory defibrillation safety margin in hypertrophic cardiomyopathy. / Okamura, Hideo; Friedman, Paul Andrew; Inoue, Yuko; Noda, Takashi; Aiba, Takeshi; Yasuda, Satoshi; Ogawa, Hisao; Kamakura, Shiro; Kusano, Kengo; Espinosa, Raul Emilio.

In: Circulation Journal, Vol. 80, No. 10, 2016, p. 2199-2203.

Research output: Contribution to journalArticle

Okamura, Hideo ; Friedman, Paul Andrew ; Inoue, Yuko ; Noda, Takashi ; Aiba, Takeshi ; Yasuda, Satoshi ; Ogawa, Hisao ; Kamakura, Shiro ; Kusano, Kengo ; Espinosa, Raul Emilio. / Single-coil defibrillator leads yield satisfactory defibrillation safety margin in hypertrophic cardiomyopathy. In: Circulation Journal. 2016 ; Vol. 80, No. 10. pp. 2199-2203.
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AU - Okamura, Hideo

AU - Friedman, Paul Andrew

AU - Inoue, Yuko

AU - Noda, Takashi

AU - Aiba, Takeshi

AU - Yasuda, Satoshi

AU - Ogawa, Hisao

AU - Kamakura, Shiro

AU - Kusano, Kengo

AU - Espinosa, Raul Emilio

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AB - Background: Single-coil defibrillator leads have gained favor because of their potential ease of extraction. However, a high defibrillation threshold remains a concern in patients with hypertrophic cardiomyopathy (HCM), and in many cases, dual-coil leads have been used for this patient group. There is little data on using single-coil leads for HCM patients. Methods and Results: We evaluated 20 patients with HCM who received an implantable cardioverter-defibrillator (ICD) on the left side in combination with a dual-coil lead. Two sets of defibrillation tests were performed in each patient, one with the superior vena cava (SVC) coil “on” and one with the SVC coil “off”. ICDs were programmed to deliver 25 joules (J) for the first attempt followed by maximum energy (35 J or 40 J). Shock impedance and shock pulse width at 25 J in each setting as well as the results of the shock were analyzed. All 25-J shocks in both settings successfully terminated ventricular fibrillation. However, shock impedance and pulse width increased substantially with the SVC coil programmed “off” compared with “on” (66.4±6.1 ohm and 14.0±1.3 ms “off” vs. 41.9±5.0 ohm and 9.3±0.8 ms “on”, P<0.0001 respectively). Conclusions: Biphasic 25-J shocks with the SVC coil ‘off’ successfully terminated ventricular fibrillation in HCM patients, indicating a satisfactory safety margin for 35-J devices. Single-coil leads appear appropriate for left-sided implantation in this patient group.

KW - Defibrillation threshold

KW - Hypertrophic cardiomyopathy

KW - Implantable cardioverter-defibrillator

KW - Single-coil leads

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