Title

A patch in the pectoral position lowers defibrillation threshold

Document Type

Journal Article

Publication Date

7-18-1997

Journal

PACE - Pacing and Clinical Electrophysiology

Volume

20

Issue

6

DOI

10.1111/j.1540-8159.1997.tb03536.x

Keywords

Defibrillation; Nonthoracotomy; Patch electrode

Abstract

Implantable pacemaker cardioverter defibrillators are now available with biphasic waveforms, which have been shown to markedly improve de fibrillation thresholds (DFTs). However, in a number of patients the DFT remains high. Also, DFT may increase after implantation, especially if antiarrhythmic drugs are added. We report on the use of a subcutaneous patch in the pectoral position in 15 patients receiving a transvenous defibrillator as a method of easily reducing the DET. A 660-mm2 patch electrode was placed beneath the generator in a pocket created on the pectoral fascia. The energy required for defibrillation was lowered by 56% on average, and the system impedance was lowered by a mean of 25%. This maneuver allowed oil patients to undergo a successful implant with adequate safety margin.

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