A patch in the pectoral position lowers defibrillation threshold
PACE - Pacing and Clinical Electrophysiology
Defibrillation; Nonthoracotomy; Patch electrode
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.
Karasik, P., Solomon, A., Verdino, R., Moore, H., Rodak, D., Hannan, R., & Fletcher, R. (1997). A patch in the pectoral position lowers defibrillation threshold. PACE - Pacing and Clinical Electrophysiology, 20 (6). http://dx.doi.org/10.1111/j.1540-8159.1997.tb03536.x