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Europace 2000 2(2):154-159; doi:10.1053/eupc.1999.0084
© 2000 by European Society of Cardiology
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Fractally coated defibrillation electrodes

Is an improvement in defibrillation threshold possible?

R. Gradaus, D. Böcker, A. Dorszewski, B. Lamp, D. Hammel1, G. Breithardt and M. Block

Westfälische Wilhelms-University Münster, Department of Cardiology & Angiology and Institute for Arteriosclerosis Research Münster, Germany; 1Department of Cardiovascular Surgery Münster, Germany

AIMS: In patients with implantable cardioverter-defibrillators (ICD), the goals of lowering the defibrillation threshold (DFT) can be achieved by means of higher defibrillation safety margins, more rapid charging of capacitors, improved battery longevity, implying smaller devices. Whether an increase in the electrically active surface of ICD leads by fractal coating results in decreased DFTs is unknown.

METHODS AND RESULTS: In this prospective randomized cross-over study the defibrillation efficacy of a novel right ventricular endocardial defibrillation electrode fractally coated with iridium was compared with an uncoated but otherwise identical electrode in 30 patients undergoing ICD implantation. In each patient, DFT testing was performed twice according to a binary search protocol introducing the two different electrodes in a random order. The mean DFT was 8·4±4·1 J with the fractally coated lead and 9·6±3·6 J using the uncoated lead. The improvement of 1·2 J was statistically not significant (P=0·11). No differences were observed between the patients with an improved DFT (n=12) and those with an unchanged or worsened DFT (n=18) concerning age, underlying cardiac disease, NYHA class, or left ventricular ejection fraction, respectively.

CONCLUSION: Increasing the electrical surface of defibrillation leads by fractal coating does not lead to a substantial clinically relevant reduction in defibrillation thresholds. Defibrillation impedance is not influenced by the increased electrical surface of the defibrillation lead.

Key Words: ICD, defibrillation threshold, fractally coated electrode

Correspondence: Rainer Gradaus, MD, Medizinische Klinik and Poliklinik, Innere Medizin C (Kardiologie and Angiologie), Westfälische Wilhelms-Universität Münster, D-48129 Münster, Germany.


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