title: Multicentre comparison Of shock efficacy using single-vs. Dual-coil lead systems and Anodal vs. cathodaL polarITY defibrillation in patients undergoing transvenous cardioverter-defibrillator implantation. The MODALITY study.
abstract: OBJECTIVE
  An optimal active-can lead configuration during implantable cardioverter defibrillator (ICD) placement is important to obtain an adequate defibrillation safety margin. The purpose of this multicenter study was to evaluate the rate of the first shock success at defibrillation testing according to the type of lead implant (single vs. dual coil) and shock polarity (cathodal and anodal) in a large series of consecutive patients who received transvenous ICDs.
  
  
  METHODS
  This was a multicenter study enrolling 469 consecutive patients. Single- versus dual-coil leads and cathodal versus anodal polarity were evaluated at defibrillation testing. In all cases, the value of the energy for the first shock was set to 20 J less than the maximum energy deliverable from the device.
  
  
  RESULTS
  A total of 469 patients underwent defibrillation testing: 158 (34 %) had dual-coil and 311 (66 %) had single-coil lead systems configuration, 254 (54 %) received anodal shock and 215 (46 %) received cathodal shock. In 35 (7.4 %) patients, the shock was unsuccessful. No significant differences in the outcome of defibrillation testing using single- versus dual-coil lead were observed but the multivariate analysis showed an increased risk of shock failure using cathodal shock polarity (OR 2.37, 95 % CI 1.12-5.03).
  
  
  CONCLUSIONS
  Both single- and dual-coil transvenous ICD lead systems were associated with high rates of successful ICD implantation, and we found no significant differences in ventricular arrhythmias interruption between the two ICD lead systems configuration. Instead, anodal defibrillation was more likely to be successful than cathodal defibrillation.
authors.affiliation: Cardiovascular Division, P. Cosma Hospital, Camposampiero, Italy, hhbacci@alice.it.
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Baccillieri
authors.forename: Gianni
authors.initials: G
authors.lastname: Gasparini
authors.forename: Luca
authors.initials: L
authors.lastname: Benacchio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.forename: Elena
authors.initials: E
authors.lastname: Marras
authors.forename: Francesca
authors.initials: F
authors.lastname: Zerbo
authors.forename: Luca
authors.initials: L
authors.lastname: Tomasi
authors.forename: Diego
authors.initials: D
authors.lastname: Vaccari
authors.forename: Gianni
authors.initials: G
authors.lastname: Pastore
authors.forename: Carlo
authors.initials: C
authors.lastname: Bonanno
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.forename: Gabriele
authors.initials: G
authors.lastname: Zanotto
authors.forename: Antonio
authors.initials: A
authors.lastname: Fusco
authors.forename: Massimo
authors.initials: M
authors.lastname: Carasi
authors.forename: Andrea
authors.initials: A
authors.lastname: Zorzi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Calzolari
authors.forename: Barbara
authors.initials: B
authors.lastname: Ignatiuk
authors.forename: Sergio
authors.initials: S
authors.lastname: Cannas
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vaglio
authors.forename: Muhamad
authors.initials: M
authors.lastname: Al Bunni
authors.forename: Antonella
authors.initials: A
authors.lastname: Pedrini
authors.forename: Armando
authors.initials: A
authors.lastname: Olivieri
authors.forename: Roberta
authors.initials: R
authors.lastname: Rampazzo
authors.forename: Nadia
authors.initials: N
authors.lastname: Minicuci
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
authors.forename: Roberto
authors.initials: R
authors.lastname: Verlato
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation* / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D019919:Prosthesis Implantation / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000517:prevention & control*