What question did this study set out to answer?

To determine the optimal transvenous lead placement to minimize voltage defibrillation thresholds in active-can implantable cardioverter-defibrillator systems.

January 1, 1999Pacing and Clinical ElectrophysiologyOpen Access

Impact of Transvenous Lead Position on Active‐Can ICD Defibrillation: A Computer Simulation Study

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Why the study?

Does transvenous lead position affect the voltage defibrillation threshold in active-can ICD systems?

Population

High resolution finite element model of a human torso that includes the fiber architecture of the…

Comparison

Various transvenous lead positions in an… vs Alternative lead positions

Design

Preclinical

Authors

FAFelipe AguelUnited States Food and Drug Administration JEJames EasonUniversity of Memphis NTNatalia A. TrayanovaElectrophysiology

Discussion

Member takes

Implication

Caution against changing ICD lead placement based on modeling alone; leaves open whether mid-cavity configurations improve real-world defibrillation success.

Key Points

To determine the optimal transvenous lead placement to minimize voltage defibrillation thresholds in active-can implantable cardioverter-defibrillator systems.
Simulated transvenous lead-to-can defibrillation configurations using a high-resolution finite element model of a human torso incorporating ventricular myocardial fiber architecture.
Evaluated voltage defibrillation thresholds across various single-lead and multi-lead positions within the right and left ventricles.
Posterior and septal positioning of single right ventricular leads yielded markedly lower voltage defibrillation thresholds compared to free-wall placements.
Increasing the effective lead surface area in the right ventricle reduced thresholds, with the lowest overall voltage defibrillation threshold achieved by combining a mid-cavity right ventricular lead and a mid-cavity left ventricular lead.
Adding a left ventricular lead reduced the size of low-gradient regions and shifted their position from the left ventricular free wall to the septum.

Structured PICO

Does transvenous lead position affect the voltage defibrillation threshold in active-can ICD systems?

Population

High resolution finite element model of a human torso that includes the fiber architecture of the ventricular myocardium

Intervention

Various transvenous lead positions (including posterior right ventricle, septal, multiple leads, and combined mid-cavity right and left ventricle leads) in an active-can defibrillation system

Comparator

Alternative lead positions (e.g., free-wall positioning, single lead systems)

Outcome

Voltage defibrillation threshold (VDFT)surrogate

Computer simulation suggests that combining mid-cavity right and left ventricular leads minimizes the voltage defibrillation threshold in active-can ICD systems.

Cite This Study

Aguel et al. (1999) studied this question.

synapsesocial.com/papers/6a702752febe604dd708f31d https://doi.org/10.1111/j.1540-8159.1999.tb00324.x

Topics

Ventricular arrhythmias Cardiac device therapy

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Implication

Caution against changing ICD lead placement based on modeling alone; leaves open whether mid-cavity configurations improve real-world defibrillation success.

Impact of Transvenous Lead Position on Active‐Can ICD Defibrillation: A Computer Simulation Study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Impact of Transvenous Lead Position on Active‐Can ICD Defibrillation: A Computer Simulation Study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

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