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Titolo:
Defibrillation thresholds are increased by right-sided implantation of totally transvenous implantable cardioverter defibrillators
Autore:
Friedman, PA; Rasmussen, MJ; Grice, S; Trusty, J; Glikson, M; Stanton, MS;
Indirizzi:
Mayo Clin & Mayo Fdn, Div Cardiovasc Dis, Rochester, MN 55905 USA Mayo Clin & Mayo Fdn Rochester MN USA 55905 Dis, Rochester, MN 55905 USA Tel Aviv Univ, Sheba Med Ctr, Inst Heart, Tel Hashomer, Israel Tel Aviv Univ Tel Hashomer Israel Ctr, Inst Heart, Tel Hashomer, Israel
Titolo Testata:
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
fascicolo: 8, volume: 22, anno: 1999,
pagine: 1186 - 1192
SICI:
0147-8389(199908)22:8<1186:DTAIBR>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
HIGH-RISK; LEAD; ELECTRODE; SYSTEM; LOCATION;
Keywords:
defibrillation; implantable defibrillator; defibrillation threshold;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
21
Recensione:
Indirizzi per estratti:
Indirizzo: Friedman, PA Mayo Clin & Mayo Fdn, Div Cardiovasc Dis, 200 1st St, Rochester, MN 55905 USA Mayo Clin & Mayo Fdn 200 1st St Rochester MN USA 55905 05 USA
Citazione:
P.A. Friedman et al., "Defibrillation thresholds are increased by right-sided implantation of totally transvenous implantable cardioverter defibrillators", PACE, 22(8), 1999, pp. 1186-1192

Abstract

Whether an ICD is placed via a left- or right-sided approach depends on venous access, the presence of a preexisting pacemaker, and other factors. Since the DFT is affected by lead position, which in turn is determined in part by the side of access, right-sided venous access could adversely affect DFTs. Furthermore, right-sided active can placement directs electric current toward the right hemithorax, which could further increase DFTs. This study sought to determine whether DFTs were increased by right-sided vascular access, and whether active can technology was beneficial or detrimental withright-sided ICD placement. Stepdown to failure DFTs were found in 290 patients receiving transvenous systems at the time of initial ICD implantation. Of these, 271 (93%) received left-sided systems and 19 (7%) received right-sided systems. The mean DFT in systems placed via left-sided vascular access was 11.3 +/- 5.3 J versus 17.0 +/- 4.9 J for right-sided implantation (P< 0.0001); right-sided DFTs were elevated for both active can and cold cansystems. Right-sided active can devices had a lower DFT than right-sided cold can systems (15 +/- 4.1 J vs 19 +/- 4.8 J, P = 0.05). The right-sided implantation of implantable defibrillators results in significantly higher DFTs than the left-sided approach. This may be due to the less favorable distribution of the defibrillating field relative to the myocardium with the devices on the right. When right-sided implantation is clinically mandated, active can devices result in lower thresholds and should be used.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/12/20 alle ore 07:31:40