Leakage of Energy to the Body Surface During Defibrillation Shock by an Implantable Cardioverter-Defibrillator (ICD) System : Experimental Evaluation During Defibrillation Shocks Through the Right Ventricular Lead and the Subcutaneous Active-Can in Canine

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The leakage of electrical current to the body surface during defibrillation shock delivery by an implantable cardioverter-defibrillator (ICD) device (the Medtronic Jewel Plus PCD system) was evaluated in 5 dogs. The defibrillation shocks were delivered between the active-can implanted in the left subclavicular region and the endocardial lead placed in the right ventricle at the energy levels of 1, 2, 8, 12, 24 and 34J. During each delivery, the electrical current leakage from the body surface was measured by electrodes connected to a circuit at 4 recording positions: (A) parallel-subcutaneous (the electrodes were fixed in the subcutaneous tissue of the left shoulder and the right lower chest, and the direction of the electrode vector was parallel to the direction of the defibrillation energy flow); (B) cross-subcutaneous (the electrodes were fixed in the subcutaneous tissue of the right shoulder and the left lower chest, and the vector of the electrodes was roughly perpendicular to the direction of the energy flow); (C) parallel-surface (the electrodes were fixed with ECG paste on the shaved skin surface at the left shoulder and the right lower chest); and (D) surface grounded (the electrodes were fixed on the shaved skin surface at the left shoulder and the left foot, which was grounded). The circuit resistance was set at a variable level (100-5, 000Ω) in accordance with the resistance measured through each canine body. Leakage energies were measured in 750 defibrillation shocks with each circuit resistance in 5 dogs. The leakage energy increased in accordance with the increase of the delivered energy and the decrease of the circuit resistance in all 4 recording positions. When the circuit resistance was set at 1, 000Ω, the leakage energy during shock delivery at 34J was 32±17mJ at position A, 5±9mJ at B, 10±9mJ at C, and 4±3mJ at D(p=0.042). The peak current was highest at position A and was 87±22mA with a circuit resistance of 1, 000Ω. The power of the leakage energy depended on the delivered energy and the impedance between the electrodes. The angle between the alignment of the recording electrodes and the direction of the energy flow was another important factor in determining the leakage energy. Although the peak current of the leakage energy reached the level of macro shock, the highest leakage energy from the body surface was considerably less because of the short duration of the shock delivery.
社団法人日本循環器学会の論文
2001-02-20

Leakage of Energy to the Body Surface During Defibrillation Shock by an Implantable Cardioverter-Defibrillator (ICD) System : Experimental Evaluation During Defibrillation Shocks Through the Right Ventricular Lead and the Subcutaneous Active-Can in Canine

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