Impact of endocardial lead position on transvenous defibrillation efficacy: a simulation study

This computational study examines the dependence of defibrillation threshold on the transvenous lead location in active-can transvenous lead defibrillation systems. Finite element models of the human thorax that incorporate (i) isotropic, (ii) realistic fiber architecture monodomain (intracellular space is ignored), and (iii) realistic fiber architecture bidomain (intracellular space accounted for) myocardial representations are used. Five right (RV) and one left (LV) ventricular transvenous lead positions and their combinations are examined. Employing the 95% critical mass above 5 V/cm DFT criterion, it was found that lv→can configuration has the lowest DFTs. Of the single RV electrodes, the posterior location resulted in the lowest DFT in the model with realistic fiber architecture