Endocardial carbon-braid electrodes: A new concept for lower defibrillation thresholds

Academic Article

Abstract

  • Background: In the treatment of patients with life-threatening ventricular arrhythmia, transvenous implantable cardioverter/defibrillators provide significant advantages over devices requiring a thoracotomy. This study tested the hypothesis that a new carbon-fiber electrode, designed at the Technische Universitat in Munich, Germany, has a lower defibrillation threshold (DFT) than standard transvenous defibrillation electrodes. Methods and Results: In 8 mongrel dogs (weight, 25.2±0.8 kg; heart weight, 192±19 g), we examined the efficacy and electrical characteristics of a right ventricular endocardial carbon prototype defibrillation electrode (9.5F, 4.4- cm2 surface) compared with a standard CPI 0062 Endotak electrode and a Medtronic 6966 Transvene endocardial right ventricular defibrillation electrode. The new electrode consists of 24 braided, tubular carbon filaments, each containing 1000 highly isotropic carbon fibers of 7-μm diameter, yielding a theoretical electrical surface of 480 cm2. The DFTs were determined in random order between each of the three right ventricular electrodes and a subcutaneous wire array anode placed on the left thorax. A standard step-down/-up DFT protocol of 20-V shock steps was applied. Two different biphasic waveforms with a 1-ms delay between phases were tested: 3.2-ms first phase/2.0-ms second phase, and 6.0-ms first phase/6.0-ms second phase. For the 3.2/2.0-ms waveform, we found a significantly lower DFT for the carbon lead (4.96±1.58 J) compared with the CPI 0062 (6.93±1.67 J) and the Medtronic 6966 (7.49±0.99 J) leads. For the 6.0/6.0-ms waveform, the DFT for the carbon electrode (5.97±2.09 J) was significantly lower than for the Medtronic 6966 lead (8.55±1.93 J) but not for the CPI 0062 lead (6.30±1.41 J). The impedance with carbon was lower than with the other two leads for the 6.0/6.0-ms waveform but not for the 3.2/2.0-ms waveform. For the carbon electrode, the 3.2/2.0-ms waveform had a lower DFT than the 6.0/6.0-ms waveform. Conclusions: The present canine study found a lower DFT for a new carbon electrode compared with DFTs for endocardial defibrillation electrodes made of standard metal. Further long-term animal studies and clinical studies are needed to determine whether carbon materials and braided-lead technology are practical and beneficial in patients.
  • Authors

    Published In

  • Circulation  Journal
  • Digital Object Identifier (doi)

    Author List

  • Alt EU; Fotuhi PC; Callihan RL; Mestre E; Smith WM; Ideker RE
  • Start Page

  • 1627
  • End Page

  • 1633
  • Volume

  • 92
  • Issue

  • 6