March 1, 2002Pacing and Clinical Electrophysiology
Human Experience with Transvenous Biventricular Defibrillation Using an Electrode in a Left Ventricular Vein
Key result
Transvenous biventricular defibrillation fails to lower defibrillation thresholds compared to standard right ventricular systems.
- n=24
Why the study?
Some ICD patients have high defibrillation thresholds due to weak shock field intensity on the left ventricle, and animal studies showed LV shocking electrodes can lower DFTs.
Does transvenous biventricular defibrillation reduce defibrillation thresholds compared to a standard right ventricular defibrillation system in patients receiving an ICD?
Population
24 patients receiving an ICD
Comparison
Transvenous biventricular defibrillation with LVA lead vs standard right ventricular defibrillation system
Design
Randomized trial with paired DFT testing and LV vein randomization
Follow-up
Acute during procedure
Authors
Discussion
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Member takes
Implication
Supports further testing of LV venous defibrillation in high-DFT ICD patients; leaves open clinical utility pending randomized trials.
Study Design
Type
RCT (n=24)
Randomization
anterior or posterior LV vein
Structured PICO
Does transvenous biventricular defibrillation reduce defibrillation thresholds compared to a standard right ventricular defibrillation system in patients receiving an ICD?
P
Population
24 patients receiving an ICD who underwent paired defibrillation threshold testing comparing standard and biventricular systems.
I
Intervention
Transvenous biventricular defibrillation using a modified guidewire as a temporary left venous access defibrillation electrode (LVA lead) advanced into a left ventricular vein
C
Comparator
Standard right ventricular defibrillation system (paired testing within the same patients)
O
Outcome
Defibrillation threshold (DFT) and safety/feasibility of LVA lead insertionsurrogate
Transvenous biventricular defibrillation is safe and feasible, but did not significantly reduce mean defibrillation thresholds compared to standard RV systems in this initial human experience.
Cite This Study
Butter et al. (2002) conducted an RCT in ICD patients (n=24). Biventricular defibrillation system vs. Standard right ventricular defibrillation system was evaluated on Mean defibrillation threshold (DFT). Transvenous biventricular defibrillation was safe and feasible in 24 ICD patients, but mean defibrillation thresholds were not statistically different from standard right ventricular systems.