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Optimizing dual threshold shocks with right- and left-ventricular electrodes: simulating defibrillation with a human thorax model

This research focuses on developing new implantable cardioverter defibrillator (ICD) dual lead configurations that reduce the defibrillation threshold (DFT) energy by delivering a second threshold shock in the area where the conventional shock's electric field is weakest. The objective of this study is to optimize electrode placements for lead systems including left-ventricular (LV) electrodes. A physiologically realistic 3D finite element model of the human thorax is employed to compute DFTs. The lead configurations investigated consist of a conventional lead system (TRIAD/sup TM/, Guidant Corporation) and additional LV shocking electrodes placed in the apical and basal portion of the posteriolateral coronary vein or directly within the TRIAD system's weak field region. The LV electrodes measure 50 mm in length and 1 mm in diameter. The computed DFT energy for the TRIAD is 6.2 J, falling within one standard deviation of the mean DFT reported in clinical studies using the TRIAD leads. LV leads located in the apical and basal portion of the posteriolateral coronary vein result in a DFT of 3.1 J, a 50% reduction from the TRIAD alone. LV leads placed in the anterior, middle, and posterior TRLAD weak field result in a DFT of 2.9 J, 2.7 J., and 3.5 J, respectively, corresponding to a 44-56% reduction in DFT from the TRIAD. The results indicate that an additional electrode placed in the proximity of the TRIAD weak field is just as effective in reducing DFTs as one placed directly within the weak field.