Use of multiple patches during implantation of epicardial defibrillator systems.
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)
Baerman
J M
JM
Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153.
Blakeman
B P
BP
Olshansky
B
B
Kopp
D E
DE
Kall
J G
JG
Wilber
D J
DJ
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
D000889:Anti-Arrhythmia Agents