Use of multiple patches during implantation of epicardial defibrillator systems
During implantation of epicardial automatic defibrillator systems, occasional patients have difficulty in obtaining adequate defibrillation thresholds. Of 236 consecutive patients undergoing implantation of epicardial defibrillator systems, 18 patients received a 3-patch (n = 15) or 4-patch (n = 3)...
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Veröffentlicht in: | The American journal of cardiology 1993, Vol.71 (1), p.68-71 |
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creator | Baerman, Jeffrey M. Blakeman, Bradford P. Olshansky, Brian Kopp, Douglas E. Kall, John G. Wilber, David J. |
description | During implantation of epicardial automatic defibrillator systems, occasional patients have difficulty in obtaining adequate defibrillation thresholds. Of 236 consecutive patients undergoing implantation of epicardial defibrillator systems, 18 patients received a 3-patch (n = 15) or 4-patch (n = 3) defibrillator system. Twelve patients who received & multiple patch defibrillator system had a best 2-patch defibrillation energy requirement of ≥30 J; in the remaining 6 patients less stringent clinical criteria were used in the decision to add a third defibrillator patch (defibrillation energy requirement >18 J in 4 patients, and >20 J in 2 patients). Technically, multiple-patch systems were made possible with either the use of Y-connectors or defibrillators allowing output to 3 patches. In 3 patients, addition of a third epicardial patch still resulted in a defibrillation energy requirement of ≥30 J; in these 3 patients, addition of a fourth patch resulted in a defibrillation energy requirement of ≤20 J. All patients receiving a multiplepatch defibrillator system had a reduction in defibrillation energy requirement, and 12 patients had a reduction in defibrillation energy requirement of ≥10 J over the best 2-patch defibrillation energy requirement in the patients who eventually had placement of a multiple-patch system, the best 2-patch defibrillation energy requirement was >18 J in 4 patients, >20 J in 2 patients, ≥30 J in 9 patients, and >40 J in 3 patients. After placement of a multiple-patch system, the defibrillation energy requirement was ≤24 J in 1 patient, ≤20 J in 5 patients, ≤18 J in 8 patients, ≤15 J in 2 patients, and ≤10 J in 2 patients. This improvement was significant (p < 0.005). During implantable defibrillator placement associated with a high defibrillation energy requirement with a 2-patch system, placement of a 3- or 4-patch system may result in a marked improvement in defibrillation energy requirement. |
doi_str_mv | 10.1016/0002-9149(93)90712-L |
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Of 236 consecutive patients undergoing implantation of epicardial defibrillator systems, 18 patients received a 3-patch (n = 15) or 4-patch (n = 3) defibrillator system. Twelve patients who received & multiple patch defibrillator system had a best 2-patch defibrillation energy requirement of ≥30 J; in the remaining 6 patients less stringent clinical criteria were used in the decision to add a third defibrillator patch (defibrillation energy requirement >18 J in 4 patients, and >20 J in 2 patients). Technically, multiple-patch systems were made possible with either the use of Y-connectors or defibrillators allowing output to 3 patches. In 3 patients, addition of a third epicardial patch still resulted in a defibrillation energy requirement of ≥30 J; in these 3 patients, addition of a fourth patch resulted in a defibrillation energy requirement of ≤20 J. All patients receiving a multiplepatch defibrillator system had a reduction in defibrillation energy requirement, and 12 patients had a reduction in defibrillation energy requirement of ≥10 J over the best 2-patch defibrillation energy requirement in the patients who eventually had placement of a multiple-patch system, the best 2-patch defibrillation energy requirement was >18 J in 4 patients, >20 J in 2 patients, ≥30 J in 9 patients, and >40 J in 3 patients. After placement of a multiple-patch system, the defibrillation energy requirement was ≤24 J in 1 patient, ≤20 J in 5 patients, ≤18 J in 8 patients, ≤15 J in 2 patients, and ≤10 J in 2 patients. This improvement was significant (p < 0.005). During implantable defibrillator placement associated with a high defibrillation energy requirement with a 2-patch system, placement of a 3- or 4-patch system may result in a marked improvement in defibrillation energy requirement.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/0002-9149(93)90712-L</identifier><identifier>PMID: 8420238</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anti-Arrhythmia Agents - therapeutic use ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiac Surgical Procedures ; Defibrillators, Implantable ; Electric Countershock - methods ; Electric Power Supplies ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. 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Of 236 consecutive patients undergoing implantation of epicardial defibrillator systems, 18 patients received a 3-patch (n = 15) or 4-patch (n = 3) defibrillator system. Twelve patients who received & multiple patch defibrillator system had a best 2-patch defibrillation energy requirement of ≥30 J; in the remaining 6 patients less stringent clinical criteria were used in the decision to add a third defibrillator patch (defibrillation energy requirement >18 J in 4 patients, and >20 J in 2 patients). Technically, multiple-patch systems were made possible with either the use of Y-connectors or defibrillators allowing output to 3 patches. In 3 patients, addition of a third epicardial patch still resulted in a defibrillation energy requirement of ≥30 J; in these 3 patients, addition of a fourth patch resulted in a defibrillation energy requirement of ≤20 J. All patients receiving a multiplepatch defibrillator system had a reduction in defibrillation energy requirement, and 12 patients had a reduction in defibrillation energy requirement of ≥10 J over the best 2-patch defibrillation energy requirement in the patients who eventually had placement of a multiple-patch system, the best 2-patch defibrillation energy requirement was >18 J in 4 patients, >20 J in 2 patients, ≥30 J in 9 patients, and >40 J in 3 patients. After placement of a multiple-patch system, the defibrillation energy requirement was ≤24 J in 1 patient, ≤20 J in 5 patients, ≤18 J in 8 patients, ≤15 J in 2 patients, and ≤10 J in 2 patients. This improvement was significant (p < 0.005). During implantable defibrillator placement associated with a high defibrillation energy requirement with a 2-patch system, placement of a 3- or 4-patch system may result in a marked improvement in defibrillation energy requirement.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac Surgical Procedures</subject><subject>Defibrillators, Implantable</subject><subject>Electric Countershock - methods</subject><subject>Electric Power Supplies</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. 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Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac Surgical Procedures</topic><topic>Defibrillators, Implantable</topic><topic>Electric Countershock - methods</topic><topic>Electric Power Supplies</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Equipment Design</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Patients</topic><topic>Stroke Volume - physiology</topic><topic>Transplants & implants</topic><topic>Ventricular Fibrillation - therapy</topic><topic>Ventricular Function, Left - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baerman, Jeffrey M.</creatorcontrib><creatorcontrib>Blakeman, Bradford P.</creatorcontrib><creatorcontrib>Olshansky, Brian</creatorcontrib><creatorcontrib>Kopp, Douglas E.</creatorcontrib><creatorcontrib>Kall, John G.</creatorcontrib><creatorcontrib>Wilber, David J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baerman, Jeffrey M.</au><au>Blakeman, Bradford P.</au><au>Olshansky, Brian</au><au>Kopp, Douglas E.</au><au>Kall, John G.</au><au>Wilber, David J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of multiple patches during implantation of epicardial defibrillator systems</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>1993</date><risdate>1993</risdate><volume>71</volume><issue>1</issue><spage>68</spage><epage>71</epage><pages>68-71</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>During implantation of epicardial automatic defibrillator systems, occasional patients have difficulty in obtaining adequate defibrillation thresholds. Of 236 consecutive patients undergoing implantation of epicardial defibrillator systems, 18 patients received a 3-patch (n = 15) or 4-patch (n = 3) defibrillator system. Twelve patients who received & multiple patch defibrillator system had a best 2-patch defibrillation energy requirement of ≥30 J; in the remaining 6 patients less stringent clinical criteria were used in the decision to add a third defibrillator patch (defibrillation energy requirement >18 J in 4 patients, and >20 J in 2 patients). Technically, multiple-patch systems were made possible with either the use of Y-connectors or defibrillators allowing output to 3 patches. In 3 patients, addition of a third epicardial patch still resulted in a defibrillation energy requirement of ≥30 J; in these 3 patients, addition of a fourth patch resulted in a defibrillation energy requirement of ≤20 J. All patients receiving a multiplepatch defibrillator system had a reduction in defibrillation energy requirement, and 12 patients had a reduction in defibrillation energy requirement of ≥10 J over the best 2-patch defibrillation energy requirement in the patients who eventually had placement of a multiple-patch system, the best 2-patch defibrillation energy requirement was >18 J in 4 patients, >20 J in 2 patients, ≥30 J in 9 patients, and >40 J in 3 patients. After placement of a multiple-patch system, the defibrillation energy requirement was ≤24 J in 1 patient, ≤20 J in 5 patients, ≤18 J in 8 patients, ≤15 J in 2 patients, and ≤10 J in 2 patients. This improvement was significant (p < 0.005). During implantable defibrillator placement associated with a high defibrillation energy requirement with a 2-patch system, placement of a 3- or 4-patch system may result in a marked improvement in defibrillation energy requirement.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>8420238</pmid><doi>10.1016/0002-9149(93)90712-L</doi><tpages>4</tpages></addata></record> |
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subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Arrhythmia Agents - therapeutic use Biological and medical sciences Cardiac arrhythmia Cardiac Surgical Procedures Defibrillators, Implantable Electric Countershock - methods Electric Power Supplies Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Equipment Design Follow-Up Studies Humans Intensive care medicine Medical research Medical sciences Patients Stroke Volume - physiology Transplants & implants Ventricular Fibrillation - therapy Ventricular Function, Left - physiology |
title | Use of multiple patches during implantation of epicardial defibrillator systems |
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