Journal Article

Fractally coated defibrillation electrodes

R. Gradaus, D. Böcker, A. Dorszewski, B. Lamp, D. Hammel, G. Breithardt and M. Block

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 2, issue 2, pages 154-159
Published in print April 2000 | ISSN: 1099-5129
Published online April 2000 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1053/eupc.1999.0084
Fractally coated defibrillation electrodes

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Aims

In patients with implantable cardioverter-defibrillators (ICD), the goals of lowering the defibrillation threshold (DFT) can be achieved by means of higher defibrillation safety margins, more rapid charging of capacitors, improved battery longevity, implying smaller devices. Whether an increase in the electrically active surface of ICD leads by fractal coating results in decreased DFTs is unknown.

Methods and Results

In this prospective randomized cross-over study the defibrillation efficacy of a novel right ventricular endocardial defibrillation electrode fractally coated with iridium was compared with an uncoated but otherwise identical electrode in 30 patients undergoing ICD implantation. In each patient, DFT testing was performed twice according to a binary search protocol introducing the two different electrodes in a random order. The mean DFT was 8·4±4·1 J with the fractally coated lead and 9·6±3·6 J using the uncoated lead. The improvement of 1·2 J was statistically not significant (P=0·11). No differences were observed between the patients with an improved DFT (n=12) and those with an unchanged or worsened DFT (n=18) concerning age, underlying cardiac disease, NYHA class, or left ventricular ejection fraction, respectively.

Conclusion

Increasing the electrical surface of defibrillation leads by fractal coating does not lead to a substantial clinically relevant reduction in defibrillation thresholds. Defibrillation impedance is not influenced by the increased electrical surface of the defibrillation lead.

Keywords: ICD; defibrillation threshold; fractally coated electrode

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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