Implantable Intravascular Defibrillator: Evaluation of Defibrillation Waveforms with Inferior Vena Cava Electrode System

BACKGROUND: A percutaneously placed, totally intravascular defibrillator has been developed that shocks via a right ventricular (RV) single-coil and titanium electrodes in the superior vena cava (SVC) and the inferior vena cava (IVC). This study evaluated the defibrillation threshold (DFT) with this electrode configuration to determine the effect of different biphasic waveform tilts and second-phase durations as well as the contribution of the IVC electrode. METHODS: Eight Bluetick hounds (wt = 30-40 kg) were anesthetized and the RV coil (first-phase anode) was placed in the RV apex. The intravascular defibrillator (PICD®, Model no. IIDM-G, InnerPulse Inc., Research Triangle Park, NC, USA) was positioned such that the titanium electrodes were in the SVC and IVC . Ventricular fibrillation was electrically induced and a Bayesian up-down technique was employed to determine DFT with two configurations: RV to SVC + IVC and RV to SVC. Three waveform tilts (65%, 50%, and 42%) and two second-phase durations (equal to the first phase [balanced] and truncated at 3 ms [unbalanced]) were randomly tested. The source capacitance of the defibrillator was 120 μF for all waveforms. RESULTS: DFT with the IVC electrode was significantly lower than without the IVC electrode for all waveforms tested (527 ± 9.3 V [standard error], 14.5 J vs 591 ± 7.4 V, 18.5 J, P < 0.001). Neither waveform tilt nor second-phase duration significantly changed the DFT. CONCLUSION: In canines, a totally intravascular implantable defibrillator with electrodes in the RV apex, SVC, and IVC had a DFT similar to that of standard nonthoracotomy lead systems. No significant effect was noted with changes in tilt or with balanced or unbalanced waveforms.