{"id":"19377963580f","type":"article","url":"https://hartvaat.nl/2017/11/01/defibrillatie-drempelwaarden-bij-rechtspectorale-icd-en-golfvorm-tuning/","title":"Defibrillatie-drempelwaarden bij rechtspectorale ICD en golfvorm-tuning","title_en":"Defibrillation thresholds with right pectoral implantable cardioverter defibrillators and impact of waveform tuning (the Tilt and Tune trial).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["icd-implantatie","ventrikelfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw306","source_url":"https://doi.org/10.1093/europace/euw306","authors":["Niraj Varma","Raymond Schaerf","Steven Kalbfleisch","Rhea Pimentel","Mark W Kroll","Ashish Oza"],"significance":4,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":[],"congress":"","summary_en":"This randomised study assessed defibrillation thresholds with right pectoral ICD implantation and evaluated whether waveform tuning optimisation improves defibrillation efficacy in this configuration.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar defibrillatie-drempelwaarden bij rechtspectoraal geïmplanteerde ICD's en het effect van golfvorm-optimalisatie.","abstract_original":"AIMS: Assess defibrillation thresholds (DFTs) with right active pectoral implantable cardioverter defibrillator (RICDs). Defibrillation thresholds in patients receiving RICDs are regarded as 'high' and potentially improved by waveform optimization (tuning). However, this has not been systematically tested. METHODS AND RESULTS: Patients receiving RICDs [Single chamber (VVI) = 16, DDD = 32, cardiac resynchronization therapy (CRT) = 43] were randomized to either 50/50% fixed tilt (FT) or tuned waveform (3.5 ms time constant based). Defibrillation threshold was tested with a binary search protocol in single coil anodal configuration. Then RICDs were compared with left-sided placements. Baseline patient characteristics in FT (n = 54) and tuned (n = 37) were similar (65 ± 14 years, 71% male, Left ventricular ejection fraction 31 ± 13%; and proportions VVI/DDD/Cardiac resynchronization therapy defibrillator). Tuning reduced Phase 1 by 15% and Phase 2 by 45%. For FT vs. tuned: high voltage impedance was 61.9 ± 13.2 vs. 64.5 ± 12.7 Ω (P = 0.33) and mean DFT 14.2 ± 8.8 vs. 14.9 ± 9.2 J (P = 0.8). When high voltage impedance was >62 Ω (mean 73.6 ± 8.6 Ω), DFT was identical [FT 13.0 ± 7.9 J vs. tuned 12.0 ± 5.9 J (P= 0.7)]. Defibrillation thresholds exceeded 20 J (600 V) in >20% of patients [FT 11/54 (20.4%) vs. tuned 12/37 (32%) patients]. Defibrillation threshold with RICD was greater and exhibited wider dispersion compared with left ICDs (n = 54) under similar conditions. CONCLUSION: This first randomized trial investigating DFTs with right ICDs confirms relatively higher DFTs with RICDs than reported for left pectoral ICDs. However, DFTs were generally unaffected by 3.5 ms time constant-based waveform tuning compared with a 50% tilt waveform. Implant testing may be preferred with RICDs. CLINICAL TRIAL NUMBER: NCT00873691."}