Optimizing electrode placement in a proposed ICD system incorporating LV electrodes: finite element analysis

The objective of this study is to determine the optimal electrode positions for an ICD system including a coil electrode placed in a coronary vein on the left side of the heart. Simulations are performed using a physiologically realistic finite element model of the human thorax. Coil electrodes are placed in the RV apex along the lateral wall (RV1), RV apex along the anterior septum (RV2), superior vena cava (SVC), left intraventricular coronary vein (LVI), and posteriolateral coronary vein (LV2). An active pulse generator (Can) is placed in the subcutaneous prepectoral space. Four electrode configurations are tested: RV1+LV1→SVC+Can, RV1+LV2→SVC+Can, RV2+LV1→SVC+Can, and RV2+LV2→SVC+Can. The computed DFTs are 5.4, 4.1, 6.6, and 4.6 J, respectively. Improving defibrillation efficacy allows for reduction in pulse generator size, providing simplified pectoral implantation and a greater patient population eligible for pectoral implantation