title: Additional lead improves defibrillation efficacy with an abdominal 'hot can' electrode system.
abstract: BACKGROUND
  Although the left prepectoral site is preferred for "hot can" placement, this site is unavailable in some patients. We evaluated the influence of electrode location on defibrillation thresholds with alternative hot can and transvenous lead configurations.
  
  
  RESULTS
  Three interrelated studies were performed. In group 1, the importance of hot can location was investigated by pairing a right ventricular lead to five different hot can placement sites in seven pigs. The defibrillation energies for right pectoral, left pectoral, left subaxillary, and right and left abdominal hot can sites were 20.3+/-2.7,* 15.9+/-3.8, 14.9+/-2.5, 32.0+/-3.4,* and 30.0+/-3.4 J,* respectively (*P<.005 versus left pectoral and left subaxillary sites). In group 2, the value of a three-electrode configuration with an abdominal hot can placement was investigated by adding a subclavian vein lead to the pectoral or abdominal hot can configurations in seven pigs. The defibrillation energies for left pectoral and abdominal sites were 18.6+/-4.2 and 29.0+/-5.8 J (P=.0001), respectively. The addition of a right or left subclavian vein lead with an abdominal hot can reduced the threshold to 19.3+/-4.2* or 18.8+/-3.2,* respectively (*P=.0001 versus abdominal site). In group 3, the contribution of the abdominal hot can electrode to the three-electrode configuration was tested by a comparison with two purely transvenous two-electrode configurations in six pigs. The defibrillation energy (19.9+/-3.2 J) for the abdominal hot can with a subclavian vein lead was lower than the transvenous lead configurations with a subclavian vein (29.0+/-2.5 J, P=.0001) or a superior vena cava lead (30.7+/-3.7 J, P=.0001). The right ventricular lead was the sole cathode during the first phase of the biphasic shock in all experiments.
  
  
  CONCLUSIONS
  Defibrillation energy depends on the hot can placement site. The addition of a subclavian vein lead with an abdominal hot can improves defibrillation efficacy to the level of the pectoral placement and is better than a purely transvenous lead configuration.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamanouchi
authors.forename: K A
authors.initials: KA
authors.lastname: Mowrey
authors.forename: M J
authors.initials: MJ
authors.lastname: Niebauer
authors.forename: P J
authors.initials: PJ
authors.lastname: Tchou
authors.forename: B L
authors.initials: BL
authors.lastname: Wilkoff
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000818:Animals; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D013350:Subclavian Vein; D013552:Swine