Abstract
The implantable cardioverter defibrillator with an active can and a single coil lead is effective in treating ventricular fibrillation, but the lead placement associated with the high defibrillation efficacy is still controversial and remains largely empirical. In this study, an anatomically realistic finite difference model of the thorax was developed based on MRI cross-sectional images of a human thorax to examine the effect of transvenous coil placement on defibrillation efficacy. Four electrode configurations with the coil was placed, respectively, in the right ventricular (RV) apex, in the middle of RV cavity, along the free wall in RV, or along the septal wall in RV, were simulated and their defibrillation efficacies were evaluated based on a set of metrics including voltage defibrillation threshold, current defibrillation threshold, interelectrode impedance, potential gradient distribution uniformity, current density distribution, and myocardium damage. It was found that the optimal electrode configuration is to position the coil in the middle of the RV cavity. The results were compared with the results from a simplified thoracic model. The comparison indicates that for a given electrode configuration a simplified representation of the thorax may overestimate defibrillation efficacy.
Similar content being viewed by others
References
Aguel F., Eason J. C., Trayanova N. A., Siekas G., Fishler M. G. (1999) Impact of transverous lead position on active can ICD defibrillation: a computer simulation study. Pacing Clin. Electrophysiol. 22:158–164
Babbs C. F., Tacker W. A., VanVleet J. F., Bourland J. D., Geddes L. A. (1989) Therapeutic indices for transchest defibrillator shocks: Effective, damaging, and lethal electrical doses. Am. Heart. J. 99:734–738
Bardy G. H., Troutman C., Johnson G. (1991) Electrode system influence on biphasic waveform defibrillation efficacy in humans. Circulation 84:665–671
Cappato R. (1999) Secondary prevention of sudden death: the Dutch study, the antiarrhythmics versus implantable defibrillator trial, the cardiac arrest study Hamburg, and the Canadian implantable defibrillator study. Am. J. Cardiol. 83:68D–73D
Claydon F. J., Pikington T. C., Tang A. S. L., Morrow M. N., Ideker R. E. (1988) A volume conductor model of the thorax for the study of defibrillation fields. IEEE Trans. Biomed. Eng. 35:981–992
Eason J., Schmidt J., Dabasinskas A., Siekas G., Aguel F., Trayanova N. (1998) Influence of anisotropy on local and global measures of potential gradient in computer models of defibrillation. Ann. Biomed. Eng. 26:840–849
Frazier D. W., Wolf P. D., Wharton J. M., Tang A. S. L., Smith W. M., Ideker R. E. (1989) Stimulus-induced critical point: Mechanism for electrical initiation of reentry in normal canine myocardium. J. Clin. Invest. 83:1039–1052
Gabriel S., Lau R. W., Gabriel C. (1996) The dielectric properties of biological tissue: II. Measurements in the frequency range 10 Hz to 20 GHz. Phys. Med. Biol. 41:2251–2269
Geddes L. A., Baker E. L. (1967) The specific resistance of biological material-a compendium of data for the biomedical engineer and physiologist. Med. & Biol. Engng. 5:271–293
Geddes L. A., Tacker W. A., Rosborough J. P., Moors A. G., Cabler P. S. (1974) Electrical dose for ventricular defibrillation of large and small animals using precordial electrodes. Clin. Invest. 53:310–319
Gold M. R., Foster A. H., Shorofsky S. R. (1996) Effects of an active pectoral-pulse generator shell on defibrillation efficacy with a transvenous lead system. Am. J. Cardiol. 78:540–543
Gold M. R., Foster A. H., Shorofsky S. R. (1997) Lead system optimization for transvenous defibrillation. Am. J. Cardiol. 80(9):1163–1167
Gold M. R., Olsovsky M. R., Degroot P. J., Cuello C., Shorofsky S. R. (2000) Optimization of transvenous coil position for active can defibrillation thresholds. J. Cardiovasc. Electrophysiol. 11(1):25–29
Holzer J. R., Fong L. E., Sidorov V. Y., Wikswo J. P., Baudenbacher F. (2004) High resolution magnetic images of planar wave fronts reveal bidomain properties of cardiac tissue. Biophys. J. 87:4326–4332
Ideker R. E., Wolf P. D., Alferness C., Krassowska W., Smith W. M. (1991) Current concepts for selecting the location, size, and shape of defibrillation electrodes. Pacing Clin. Electrophysiol. 14:227–240
Jones J. L., Jones R. E., Balasky G. (1987) Microlesion formation in myocardial cells by high-intensity electric field stimulation. Heart Circ. Physiol. 22:H480–H486
Jongh A. L. D., Entcheva E. G., Replogle J. A., Booker P. S., Kenknight B. H., Claydon F. (1999) Defibrillation efficacy of different electrode placements in a human thorax model. Pacing Clin. Electrophysiol. 22:152–157
Karlon W. J., Eisenberg S. R., Lehr J. L. (1993) Effect of paddle placement and size on defibrillation current distribution: A three dimensional finite element method. IEEE Trans. Biomed. Eng. 40:246–255
Kinst T. F., Sweeney M. O., Lehr J. L., Eisenbery S. R. (1997) Simulated internal defibrillation in humans using an anatomically realistic three-dimensional finite element model of the thorax. J. Cardiovasc. Electrophysiol. 8:537–547
Knisley S. B., Trayanova N., Aguel F. (1999) Roles of electric field and fiber structure in cardiac electric stimulation. Biophys. J. 77(3):1404–1417
Kodama I., Shibata N., Sakuma I., Mitsui K., Iida M., Suzuki R., Fukui Y., Hosoda S., Toyama J. (1994) Aftereffects of high-intensity DC stimulation on the electromechanical performance of ventricular muscle. Am. J. Physiol. Heart. Circ. Physiol. 36:H248–H258
Krum D., Hare J., Mughal K., Jazayeri M. R., Deshpande S., Dhala A., Blanck Z., Akhtar M., Sra J. (1998) Optimization of shocking lead configuration for transvenous atrial defibrillation. J. Cardiovasc. Electrophysiol. 9(9):998–1003
Lee K. L., Hafley G., Fisher J. D. (2002) Multicenter unsustained tachycardia trial investigator: effect of implantable defibrillators on arrhythmic events and mortality in the multicenter unsustained tachycardia trial. Circulation 106:233–238
Lepeschkin E., Jones J., Rush S. (1978) Local potential gradients as a unifying measure for thresholds of stimulation, standstill, tachyarrhythmia and fibrillation appearing after strong capacitor discharges. Adv. Cardiol. 21:268–278
Mocanu D., Kettenbach J., Sweeney M. O., Kikinis R., Kenknight B. H., Eisenberg S. R. (2004) A comparison of biventricular and conventional transvenous defibrillation: A computational study using patient derived models. Pacing Clin. Electrophysiol. 27:586–593
Modre R., Seger M., Fischer G., Hintermüller C., Hayn D., Pfeifer B., Hanser F., Schreier G., Tilg B. (2006) Cardiac anisotropy: is it negligible regarding noninvasive activation time imaging? IEEE Tran. Biomed. Eng. 53:569–580
Nikolski V. P., Sambelashvili A. T., Efimov I. R. (2001) Mechanisms of make and break excitation revisited: paradoxical break excitation during diastolic stimulation. Am. J. Physiol. Heart. Circ. Physiol. 282:565–575
Olsovsky M. R., Kavesh N. G., Pelini M. A., Shorofsky S. R., Gold M. R. (1997) Optimization of active can defibrillation lead systems. Circulation 96(8):3242–3242
Plonsey R., Heppner D. B. (1967) Considerations of quasistationarity in electrophysiological systems. Bull. Math. Biophys. 29(4):657–664
Raitt M.H., Johnson G., Dolack G.L. (1995) Clinical predictors of the defibrillation threshold with the unipolar impantable defibrillation system. J. Am. Coll. Cardiol. 25:1576–1583
Rashba E. J., Shorofsky S. R., Peters R. W., Gold M. R. (2004) Optimization of atrial defibrillation with a dual-coil, active pectoral lead system. J. Cardiovasc. Electrophysiol. 15(7):790–794
Sakuma I., Haraguchi T., Ohuchi K., Fukui Y., Kodama I., Toyama J., Shibata N., Hosoda S. (1998) A Model Analysis of Aftereffects of High-Intensity DC Stimulation on Action Potential of Ventricular Muscle. IEEE Trans. Biomed. Eng. 45:258–267
Salazar Y., Bragos R., Casas O., Cinca J., Rosell J. (2004) Transmural versus nontransmural in situ electrical impedance spectrum for healthy, ischemic, and healed myocardium. IEEE Trans. Biomed. Eng. 51(8):1421–1427
Sepulveda N. G., Wikswo J. P., Echt D. S. (1990) Finite element analysis of cardiac defibrillation current distribution. IEEE Trans. Biomed. Eng. 37:354–365
Sharma V., Susil R. C., Tung L. (2005) Paradoxical Loss of Excitation with High Intensity Pulses during Electric Field Stimulation of Single Cardiac Cells. Biophys. J. 88:3038–3049
Singer I., Goldsmith J., Maldonado C. (1995) Transseptal defibrillation is superior for transvenous defibrillation. Pacing Clin. Electrophysiol. 18:229–232
Stanton M. S., Hayes D. L., Munger T. M. (1994) Consistent subcutantous prepectoral implantation of a new implantable cardioverter defibrillator. Mayo Clin. Proc. 69:309–314
Wang Y., Haynor D. R., Kim Y. (2001) An investigation of the importance of myocardial anisotropy in finite-element modeling of the heart: methodology and application to the estimation of defibrillation efficacy. IEEE Tran. Biomed. Eng. 48:1377–1389
Wang L., Patterson R. P. (1995) Multiple sources of the impedance cardiogram based on 3-D finite difference human thorax models. IEEE Trans. Biomed. Eng. 42:141–148
Witkowski F. X., Penkoske P. A., Plonsey R. (1990) Mechanism of cardiac defibrillation in open-chest dogs with unipolar dc-coupled simultaneous activation and shock potential recordings. Circulation 82(1):244–260
Witsoe A. D., Kinnen E. (1966) Electrical resistivity of lung at 100 kHz. Med. & Biol. Engng 5:239–248
Yabe S., Smith W. M., Daubert J. P., Wolf P. D., Rollins D. L., Ideker R. E. (1990) Conduction distribution caused by high current density electric fields. Circ. Res. 66:1190–1203
Yang F., Patterson R. P. (2007) The contribution of the lungs to thoracic impedance measurements: a simulation study based on a high resolution finite difference model. Physiol. Meas. 28:S153–S161
Yang F., Patterson R. P. (2008) A simulation study on the effect of thoracic conductivity inhomogeneities on sensitivity distributions. Ann. Biomed. Eng. 36(5):762–768
Zhang E., Shao S., Webster J. (1984) Impedance of skeletal muscle from 1 Hz to 1 MHz. IEEE Trans. Biomed. Eng. BME-31(6):477–481
Zipes D. P., Fischer J., King R. M., Nicoll A., Jolly W. W. (1975) Termination of ventricular fibrillation in dogs by depolarizing a critical amount of myocardium. Am. J. Cardiol. 36:37–44
Zipes D. P., Wyse D. G., Friedman P. L. (1997) A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N. Engl. J. Med. 337:1576–1583
Acknowledgments
We would like to thank Minnesota Supercomputing Institute for the computation resources. This study was supported in part by a gift from Earl Bakken, founder of Medtronic.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yang, F., Patterson, R. Optimal Transvenous Coil Position on Active-can Single-coil ICD Defibrillation Efficacy: A Simulation Study. Ann Biomed Eng 36, 1659–1667 (2008). https://doi.org/10.1007/s10439-008-9548-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10439-008-9548-2