title: Optimization of transvenous coil position for active can defibrillation thresholds.
abstract: BACKGROUND
  Lead systems that include an active pectoral pulse generator are now standard for initial defibrillator implantations. However, the optimal transvenous lead system and coil location for such active can configurations are unknown. The purpose of this study was to evaluate the benefit and optimal position of a superior vena cava (SVC) coil on defibrillation thresholds with an active left pectoral pulse generator and right ventricular coil.
  
  
  RESULTS
  This prospective, randomized study was performed on 27 patients. Each subject was evaluated with three lead configurations, with the order of testing randomized. Biphasic shocks were delivered between the right ventricular coil and an active can alone (unipolar), or an active can in common with the proximal coil positioned either at the right atrial/SVC junction (low SVC) or in the left subclavian vein (high SVC). Stored energies at defibrillation threshold were higher for the single-coil, unipolar configuration (11.2 +/- 6.6 J) than for the high (8.9 +/- 4.2 J) or low (8.5 +/- 4.2 J) SVC configurations (P < 0.01). Moreover, 96% of subjects had low (< or = 15 J) thresholds with the SVC coil in either position compared with 81% for the single-coil configuration. Shock impedance (P < 0.001) was increased with the unipolar configuration, whereas peak current was reduced (P < 0.001).
  
  
  CONCLUSIONS
  The addition of a proximal transvenous coil to an active can unipolar lead configuration reduces defibrillation energy requirements. The position of this coil has no significant effect on defibrillation thresholds.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore 21201, USA. MGold@medicine.ab.umd.edu
authors.forename: M R
authors.initials: MR
authors.lastname: Gold
authors.forename: M R
authors.initials: MR
authors.lastname: Olsovsky
authors.forename: P J
authors.initials: PJ
authors.lastname: DeGroot
authors.forename: C
authors.initials: C
authors.lastname: Cuello
authors.forename: S R
authors.initials: SR
authors.lastname: Shorofsky
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004056:Differential Threshold; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014683:Vena Cava, Superior; D014693:Ventricular Fibrillation / Q000628:therapy