Recovery of Pacemakers and Defibrillators for Analysis and Device Advance Directives: Electrophysiologists’ Perspectives

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87183/1/PACE_3032_sm_SuppMat.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/87183/2/j.1540-8159.2011.03032.x.pd

A patch in the pectoral position lowers defibrillation threshold

Implantable pacemaker cardioverter defibrillators are now available with biphasic waveforms, which have been shown to markedly improve de fibrillation thresholds (DFTs). However, in a number of patients the DFT remains high. Also, DFT may increase after implantation, especially if antiarrhythmic drugs are added. We report on the use of a subcutaneous patch in the pectoral position in 15 patients receiving a transvenous defibrillator as a method of easily reducing the DET. A 660-mm2 patch electrode was placed beneath the generator in a pocket created on the pectoral fascia. The energy required for defibrillation was lowered by 56% on average, and the system impedance was lowered by a mean of 25%. This maneuver allowed oil patients to undergo a successful implant with adequate safety margin

Relation of Body Mass Index to Long-Term Survival After Cardiac Resynchronization Therapy.

Obesity confers a paradoxical survival benefit in patients with heart failure, but this obesity paradox has not been well established in those who have undergone cardiac resynchronization therapy with a defibrillator (CRT-D). We sought to determine the impact of body mass index (BMI) on long-term survival in patients with heart failure after CRT-D. We identified 113 patients implanted with CRT-D at our institution from May 2002 to November 2003. Patients were divided into 3 categories by pre-implant BMI (kg/