title: Initial clinical experience with a dual lead endocardial defibrillation system with atrial pace/sense capability. United States and Canada Enguard Investigations.
abstract: Ninety-three patients underwent implants of the Telectronics Model 4211 ICD attached to the Enguard PFX endocardial defibrillation lead system. Eighty-one males and 12 females ranging in age from 25-85 years (mean = 64). Coronary disease was the substrate in the majority (88%); mean left ventricular ejection fraction was 30%. VT was present in 66%, VF in 22%, and both in 7%. Three lead configurations were used in the study: ventriculo-atrial (U1, 86%); bidirectional (B2, 12%); and ventricular to patch (U2, 2%). Mean RV pacing thresholds were 0.46 V pre- and 0.54 V posttesting, with no significant differences between the two. Mean R wave voltage was 11.05 mV pre- and 11.72 mV posttesting, also not significantly different. A subgroup of 13 patients had mean atrial pacing thresholds of 0.59 V at 0.5 msec pulse width, with mean P waves of 4.01 mV. Mean defibrillation threshold for the entire group was 10.6 J using biphasic waveforms. Defibrillation thresholds by configuration were: 399 V (U1); 475 V (U2); and 350 V (B2). All patients but one had thresholds < 550 V in at least one configuration. The 4211/Enguard system was implanted without (86%) or with (14%) a subcutaneous patch electrode. Early postoperative findings related to the ICD system include: one device circuit failure, one early lead dislodgement, and one pacing exist block.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Holy Cross Hospital, Fort Lauderdale, Florida.
authors.forename: R M
authors.initials: RM
authors.lastname: Luceri
authors.forename: P
authors.initials: P
authors.lastname: Zilo
mesh_terms: D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D004699:Endocardium; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D017180:Tachycardia, Ventricular / Q000628:therapy*; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000628:therapy*