Effect of Passive Endocardial Electrode on Defibrillation Efficacy of Nonthoracotomy Lead System

Objectives. We investigated the impact of an inactive endocardial lead on the 50% effective dose (ED50%) for successful ventricular defibrillation. Background. The presence of abandoned epicardial mesh patch electrodes detrimentally affects the defibrillation efficacy of an endocardial lead system. It is not known whether abandoned endocardial electrodes produce similar effect. Methods. An endocardial lead system (ENDOTAK, model 0062, Cardiac Pacemakers, Inc.) was implanted in eight dogs (mean ±SD weight 23.7 ± 1.0 kg). The ED50% for each of seven lead configurations was determined by three-reversal point protocol in balanced-randomized order with and without second electrically passive endocardial lead system in the right ventricle (power 0.97 to detect 50-V difference). Biphasic shocks with 80% tilt were delivered 10 s after the induction of ventricular fibrillation. In one configuration the active electrode made contact with the passive electrode in the right ventricular (RV) apex. In another configuration the active electrode was placed in more proximal position to avoid contact. Additionally, the ED50% was determined for the endocardial lead system with passive pacing lead positioned in the RV apex. Results. ED50% values for peak voltage, peak current and delivered energy were not significantly different with or without passive RV electrode, and this was true whether or not the active electrode touched the passive electrode. However, ED50% values were significantly higher when the active electrode was slightly proximal than when it was positioned at the apex. Conclusions. Physical contact between active and passive endocardial electrodes does not significantly alter defibrillation efficacy in this dog model. An increase in ED50% energy was caused by slightly proximal position. Therefore, good electrode position within the right ventricle is more important determinant of defibrillation efficacy than is avoidance of the electrode touching passive electrode.