Journal of the American College of Cardiology
-
J. Am. Coll. Cardiol. · Mar 1988
Randomized Controlled Trial Comparative Study Clinical TrialSequential pulse defibrillation in humans: orthogonal sequential pulse defibrillation with epicardial electrodes.
A newly described sequential pulse technique, using four mesh electrodes positioned to approximate a true orthogonal system around the heart, was compared with a single pulse system using two of these same electrodes, which were located in positions that would be used for an automatic implantable defibrillator. The influence of electrode size was also assessed. The minimal energy necessary for defibrillation (defibrillation threshold) was determined intraoperatively in 21 volunteer patients undergoing accessory pathway ablation of Wolff-Parkinson-White syndrome. ⋯ Defibrillation thresholds were determined in three groups of patients: 1) those with four small mesh electrodes (6 cm2), 2) those with two small and two large (13 cm2) mesh electrodes, and 3) those with four large mesh electrodes. In all cases, the average minimal energy needed for sequential pulse defibrillation was less than that required for single pulse defibrillation in the same patients with the same electrodes (four small, 24.8 +/- 24.7 J single versus 6.7 +/- 8.3 J sequential; two small plus two large, 11.4 +/- 15.0 J single versus 2.7 +/- 1.4 J sequential; four large, 8.1 +/- 5.3 J single versus 3.9 +/- 2.6 J sequential). Using the 6 cm2 electrodes for single pulse defibrillation energies delivered at greater than 45 J in two patients failed to defibrillate the heart.(ABSTRACT TRUNCATED AT 250 WORDS)