title: Use of multiple patches during implantation of epicardial defibrillator systems.
abstract: During implantation of epicardial automatic defibrillator systems, occasional patients have difficulty in obtaining adequate defibrillation thresholds. Of 236 consecutive patients undergoing implantation of epicardial defibrillator systems, 18 patients received a 3-patch (n = 15) or 4-patch (n = 3) defibrillator system. Twelve patients who received a multiple-patch defibrillator system had a best 2-patch defibrillation energy requirement of > or = 30 J; in the remaining 6 patients less stringent clinical criteria were used in the decision to add a third defibrillator patch (defibrillation energy requirement > 18 J in 4 patients, and > 20 J in 2 patients). Technically, multiple-patch systems were made possible with either the use of Y-connectors or defibrillators allowing output to 3 patches. In 3 patients, addition of a third epicardial patch still resulted in a defibrillation energy requirement of > or = 30 J; in these 3 patients, addition of a fourth patch resulted in a defibrillation energy requirement of < or = 20 J. All patients receiving a multiple-patch defibrillator system had a reduction in defibrillation energy requirement, and 12 patients had a reduction in defibrillation energy requirement of > or = 10 J over the best 2-patch defibrillation energy requirement. In the patients who eventually had placement of a multiple-patch system, the best 2-patch defibrillation energy requirement was > 18 J in 4 patients, > 20 J in 2 patients, > or = 30 J in 9 patients, and > 40 J in 3 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153.
authors.forename: J M
authors.initials: JM
authors.lastname: Baerman
authors.forename: B P
authors.initials: BP
authors.lastname: Blakeman
authors.forename: B
authors.initials: B
authors.lastname: Olshansky
authors.forename: D E
authors.initials: DE
authors.lastname: Kopp
authors.forename: J G
authors.initials: JG
authors.lastname: Kall
authors.forename: D J
authors.initials: DJ
authors.lastname: Wilber
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods; D011211:Electric Power Supplies; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D013318:Stroke Volume / Q000502:physiology; D014693:Ventricular Fibrillation / Q000628:therapy; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D000889:Anti-Arrhythmia Agents