Examination of a middle cardiac vein defibrillation coil as stand-alone anode, auxiliary anode, and bystander electrode in a transvenous defibrillation circuit

In porcine studies anodes in the middle cardiac vein compare favorably with those in the RV. It has not been demonstrated whether the RV and middle cardiac vein or the middle cardiac vein alone anodes are superior when shocking to a conventional SVC and active housing cathode nor whether a bystander middle cardiac vein electrode exerts a passive electrode affect. Twelve pigs were anesthetized and had an active housing implanted in the left pectoral region and defibrillation coils placed at the RV apex and in the SVC. A custom-made defibrillation coil (Ela Medical) was advanced into the middle cardiac vein through a 9 Fr transvenous catheter. The DFT for three anodes (RV; RV and middle cardiac vein; middle cardiac vein) to the SVC and active housing was then assessed by a three reversal binary search, the order of testing was randomized. In seven animals DFT was assessed in the same way for the configuration of RV to SVC and active housing twice more, with and without a bystander middle cardiac vein coil electrode in place. The results were middle cardiac vein 7.5 ± 1.7 J, RV and middle cardiac vein 7.3 ± 1.7 J reduced DFT significantly compared to RV 13.8 ± 4.2 J (both P < 0.000). There was no significant difference between the middle cardiac vein and the middle cardiac vein and RV (P = 0.67, 95% CI for difference ? 0.64–0.96). The DFT of RV to SVC and the active housing was the same with (13.2 ± 4.0) and without (13.7 ± 4.2) the middle cardiac vein bystander coil in place (P = 0.177, 95% CI for difference ? 0.33–1.33 J). Shocking to a SVC and active housing cathode, middle cardiac vein, and RV and middle cardiac vein anodes are equally effective in lowering DFT compared to the RV. The middle cardiac vein coil electrode does not exert a passive electrode affect on the RV to the SVC and active housing defibrillation