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A novel low-energy electrotherapy that terminates ventricular tachycardia with
lower energy than a biphasic shock when antitachycardia pacing fails
#MMPMID23141483
Janardhan AH
; Li W
; Fedorov VV
; Yeung M
; Wallendorf MJ
; Schuessler RB
; Efimov IR
J Am Coll Cardiol
2012[Dec]; 60
(23
): 2393-8
PMID23141483
show ga
OBJECTIVES: The authors sought to develop a low-energy electrotherapy that
terminates ventricular tachycardia (VT) when antitachycardia pacing (ATP) fails.
BACKGROUND: High-energy implantable cardioverter-defibrillator (ICD) shocks are
associated with device failure, significant morbidity, and increased mortality. A
low-energy alternative to ICD shocks is desirable. METHODS: Myocardial infarction
was created in 25 dogs. Sustained, monomorphic VT was induced by programmed
stimulation. Defibrillation electrodes were placed in the right ventricular apex,
and coronary sinus and left ventricular epicardium. If ATP failed to terminate
sustained VT, the defibrillation thresholds (DFTs) of standard versus
experimental electrotherapies were measured. RESULTS: Sustained VT ranged from
276 to 438 beats/min (mean 339 beats/min). The right ventricular-coronary sinus
shock vector had lower impedance than the right ventricular-left ventricular
patch (54.4 ± 18.1 ? versus 109.8 ± 16.9 ?; p < 0.001). A single shock required
between 0.3 ± 0.2 J to 5.9 ± 2.5 J (mean 2.64 ± 3.22 J; p = 0.008) to terminate
VT, and varied depending upon the phase of the VT cycle in which it was
delivered. By contrast, multiple shocks delivered within 1 VT cycle length were
not phase dependent and achieved lower DFT compared with a single shock (0.13 ±
0.09 J for 3 shocks, 0.08 ± 0.04 J for 5 shocks, and 0.09 ± 0.07 J for 7 shocks;
p < 0.001). Finally, a multistage electrotherapy (MSE) achieved significantly
lower DFT compared with a single biphasic shock (0.03 ± 0.05 J versus 2.37 ± 1.20
J; respectively, p < 0.001). At a peak shock amplitude of 20 V, MSE achieved
91.3% of terminations versus 10.5% for a biphasic shock (p < 0.001). CONCLUSIONS:
MSE achieved a major reduction in DFT compared with a single biphasic shock for
ATP-refractory monomorphic VT, and represents a novel electrotherapy to reduce
high-energy ICD shocks.
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