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
Hauptverfasser: Baerman, Jeffrey M., Blakeman, Bradford P., Olshansky, Brian, Kopp, Douglas E., Kall, John G., Wilber, David J.
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container_end_page 71
container_issue 1
container_start_page 68
container_title The American journal of cardiology
container_volume 71
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 &amp; 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 &gt;18 J in 4 patients, and &gt;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 &gt;18 J in 4 patients, &gt;20 J in 2 patients, ≥30 J in 9 patients, and &gt;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 &lt; 0.005). 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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 &amp; 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 &gt;18 J in 4 patients, and &gt;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 &gt;18 J in 4 patients, &gt;20 J in 2 patients, ≥30 J in 9 patients, and &gt;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 &lt; 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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