EFFECT OF SHOCK POLARITY ON VENTRICULAR DEFIBRILLATION THRESHOLD USING A TRANSVENOUS LEAD SYSTEM

Objectives. The purpose of this study was to determine whether the pol arity of a monophasic shock used with a transvenous lead system affect s the defibrillation threshold. Background. The ability to implant an automatic defibrillator depends on achieving an adequate defibrillatio n threshold. Methods. A transvenous defibrillation lead with distal an d proximal shocking electrodes was used in this study. In 29 consecuti ve patients, the defibrillation threshold, using a step down protocol was determined twice in random order: 1) with the distal coil as the a node, and 2) with the polarity reversed. Only the 20 patients in whom an adequate defibrillation threshold could be obtained with the transv enous lead alone were included in this study. These patients were 61 /- 14 years old (mean +/- SD) and had a mean ejection fraction of 28 /- 12%. Results. The mean defibrillation threshold was 11.5 +/- 5.0 J with the distal coil as the anode versus 16.9 +/- 7.7 J with the dista l coil as the cathode (p = 0.04). The defibrillation threshold was low er by a mean of 9 +/- 7 J with the former configuration in 14 patients and was lower by a mean of 7 +/- 6 J with the latter configuration in 3 patients; in 3 patients it was the same with both configurations. U se of a subcutaneous patch was avoided in five patients by utilizing t he distal electrode as the anode. Conclusions. Defibrillation threshol ds with monophasic shocks are similar to 30% lower with the distal ele ctrode as the anode. The use of anodal shocks may obviate the need for a subcutaneous patch and allow more frequent implantation of a transv enous lead system.