Defibrillation energy requirements using a left anterior chest cutaneous to subcutaneous shocking vector: Implications for a total subcutaneous implantable defibrillator

Martin C. Burke*, James A. Coman, Adam W. Cates, Curtis C. Lindstrom, David A. Sandler, Susan S. Kim, Bradley P. Knight

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Background: Subcutaneous implantable defibrillators (ICDs) are being developed to facilitate ICD implantation. Objective: The purpose of this study was to estimate the human defibrillation energy requirement (DER) using a left chest cutaneous (Q) to subcutaneous (SQ) shocking vector. Methods: Twenty patients undergoing implantation of an indicated ICD were enrolled (15 males, age = 63 ± 12 years; ejection fraction = 0.27 ± 0.14). Defibrillation testing was performed using an investigational system consisting of an external defibrillator and a constructed connector to deliver a shock between a pectoral SQ can and a cardiac apical Q electrode. Two attempts at defibrillation using this configuration were allowed. Stage 1 testing started at 70 J with a step-down/step-up to 50 or 100 J, respectively. Stage 2 testing began at 50 J with a step-down/step-up to 30 or 70 J. Results: During stage 1, a 70-J shock was successful in 7/9 (78%) patients. A second attempt was successful in 7/7 patients using a 50-J shock. In the two remaining patients, a second attempt using a 100-J shock was successful. During stage 2, a 50-J shock was successful in 10/11 (91%) patients. The protocol could not be completed in 2/11 patients. Of the remaining nine patients, a second defibrillation was successful in seven (78%) using a 30-J shock. Conclusions: The defibrillation energy requirement (DER) of this study vector was 50 J or less in most patients. This low DER supports further investigation of a totally SQ-ICD. However, the DER of 100 J in two patients indicates that further investigation is needed regarding DER variability and safety margins.

Original languageEnglish (US)
Pages (from-to)1332-1338
Number of pages7
JournalHeart rhythm
Volume2
Issue number12
DOIs
StatePublished - Dec 1 2005

Keywords

  • Defibrillation
  • Implantable defibrillator
  • Resuscitation
  • Subcutaneous
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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