FIRST CLINICAL EXPERIENCE WITH A NEW DUAL CHAMBER ICD SYSTEM (PCD 7271 GEM DR)








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FIRST CLINICAL EXPERIENCE WITH A NEW DUAL CHAMBER ICD SYSTEM (PCD 7271 GEM DR)
R. Höltgen, M. Wieczorek, St. Ostapczuk, G. Steiner, H. T. Nathan, W. Kurz, W. Wanke, A. Krian, K. W. Heinrich
Herzzentrum KWK Duisburg, Germany, Clinic for Cardiology and Angiology, Clinic for Thoracic- and Cardiovascular Surgery

HYPOTHESIS: Low defibrillation thresholds (DFT) can be obtained with the new PCD 7271 GEM DR II by combined use of a ventricular lead and an active can. Sensed atrial activity reveals important informations for the discrimination between supraventricular and ventricular tachyarrhythmias by a specific algorithm.
METHODS: From 11/97 to 03/98, 13 patients (pts) received a PCD 7271. All pts either survived sudden cardiac death or tested positive in the EP-Study. 8 pts had been treated with antiarrhythmic drugs at implantation time. DFT-determination was performed during implantation procedure energy, able to terminate induced ventricular fibrillation.
RESULTS: Mean DFT was 12,7± 6,4 J (6-24) in more effective current pathway. Mean pacing threshold was 0.9± 0.5V (atrium) and 0,9± 0,4V (ventricle) at 0,5 ms pulse width. Mean defibrillation impedance was 55.5± 11.1W (37-83), mean pacing impedance 497.7± 76.0W (atrium) and 633,8± 131,4W (ventricle). In one patient, effective defibrillation could only be obtained by additional use of a subcutaneous arrayelectrode. In another pt the PCD 7271 was connected to a former implanted dual coil electrode (Endotak). In all pts 121 episodes of supraventricular tachycardia were detected and differentiated from tachyarrhythmias of ventricular origin. 95 episodes of VT were effectively treated by ATP in 94 cases.
CONCLUSION: A safety margin of 10 J is generally accepted in ICD systems. The PCD 7121 GEM DR with a maximum energy of 35 J provides a convenient defibrillation safety. Differentiation between ventricular and supraventricular rhythms proved to be highly effective.


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