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Biomedical subjects

E Hoffmann

Publications and source records attributed to E Hoffmann.

At least 91 records · Page 5Linked to original sources
PubMed1998

[Toy cap pistols and their effect on hearing].

In order to understand the repeated occurrences of auditory impairments caused by toy pistols, an analysis of the circumstances involved was performed at Justus-Liebig University of Giessen. The acoustic impact of toy pistols on the ear was determined with a special measuring system for impulse noise. Results were compared with the acoustic impacts of the G3 common rifle of the German military on the ear of the soldier. It was apparent that all of the five randomly selected types of toy pistols were much louder than the military rifle, if fired close to the ear. The current standard of the European Union related to the safety of toys (EN 71-1) tolerates peaks of impulse noise from toy pistols that are actually illegal for workplaces without auditory protection. Measurements showed that the toy pistols tested were even louder than that tolerated by the EU standard. Problems related to acute acoustic trauma caused by these toys are discussed using recent examples. In order to prevent such injuries, we suggest limiting the loudness of the "worst case" instead of using unrealistic measurements.

Auditory Fatigue↗
PubMed1998

[Epidermal growth factor (EGF) in tears in excimer laser photorefractive keratectomy. Responsible for postoperative refraction and "haze"?].

BACKGROUND: Corneal wound healing is of critical importance for the postoperative outcome of excimer laser PRK. Wound healing is a complex biological process that is well characterised at the microscopic level, but its regulation is poorly understood at the molecular level. Among various cytokines, epidermal growth factor (EGF) plays an important role in superficial wound healing. The synthesis of EGF varies individually; therefore, by determining the EGF concentration in the tear fluid, patients with increased wound healing activity might be traced. METHODS: In this study we measured the EGF concentration pre- and postoperatively in the tear fluid of 50 eyes using a ELISA test. The preoperative refraction was between -2.00 and -10.00 dioptres. The maximum follow-up was 6 months. RESULTS: Preoperatively, in all eyes the EGF concentration in the tear fluid was between 0.2 and 1.7 ng/ml. In contrast, 1 week postoperatively, these values increased (0.21-22.50 ng/ml); 4 weeks postoperatively, the EGF concentration was in all eyes back to preoperative levels. In eyes with high EGF tear fluid concentration 1 week after surgery, refraction at 6 months was outside the intended correction of +/- 1.0 D. We could not find any correlation between EGF concentration and "corneal haze". CONCLUSIONS: EGF may play an important role in postoperative wound healing after excimer laser PRK. Investigations concerning a pharmaceutical control of EGF should be undertaken.

Adult↗
PubMed1998

[Electro-anatomic mapping of the sinoatrial activation: initial experiences with the new CARTO mapping system].

Prerequisite for successful radiofrequency catheter ablation on tachycardias is the exact mapping during the electrophysiologic study. The new mapping system CARTO allows a three-dimensional color-coded electroanatomic map of impulse propagation using electromagnetic technology. Mapping of sinuatrial activation in the right atrium of 11 patients represents the first clinical experience with this new system. The physiological activation sequence could be determined in all patients three-dimensionally, and the sinus node could be localized as a physiological activation focus with interindividual variability only in the sagital plane without complications. The nonfluoroscopic mapping system allows high resolution visualization of electrical activity and may therefore improve precision and simplify the determination of the arrhythmogenic substrate during tachycardias for successful catheter ablation.

Adult↗
PubMed1998

[Repetitive monomorphic ventricular tachycardia (Gallavardin type): clinical and electrophysiological characteristics in 20 patients].

Repetitive monomorphic ventricular tachycardia (RMVT) is defined by the presence of numerous monomorphic isolated, premature ventricular complexes, couplets, and runs of unsustained ventricular tachycardia having the same morphology in patients without structural heart disease. Patients with RMVT mostly demonstrate the typical left bundle branch block morphology with normal or rightward axis during tachycardia. At our institution, 20 patients with RMVT have been systematically studied: a syncope had occurred in 35% of our patients, in three cases a syncope was the first manifestation of the RMVT. Of our RMVT patients, 25% developed sustained episodes (> 3 min) of ventricular tachycardia as documented by Holter ECG. The salvos of ventricular tachycardia are generally short in RMVT. This behavior and the typical exercise dependence differentiates RMVT from paroxysmal sustained idiopathic ventricular tachycardia. Exercise testing is mandatory for correct diagnosis of RMVT. In our institution, 85-90% of RMVT patients demonstrated runs of ventricular tachycardia or sustained ventricular tachycardia while on a treadmill (exercise test) or during isoproterenol infusion. RMVT was inducible by programmed electrical right ventricular stimulation in only 13% of our patients. Therefore, in patients with suspected RMVT programmed electrophysiological stimulation is only useful to differentiate a ventricular tachycardia from a supraventricular tachycardia with bundle brunch block or in patients with unexplained syncope. The prognosis is considered generally good; in our patients no life threatening ventricular tachyarrhythmias were observed during a follow-up of up to 4 years. Verapamil and beta-adrenoceptor antagonists generally offer symptomatic improvement. In some cases treatment with a class III antiarrhythmic agent is necessary. While drug-refractory paroxysmal sustained idiopathic ventricular tachycardia can be abladed with both immediate and long-term success, catheter ablation of RMVT is only rarely indicated.

Adult↗
PubMed1998

[Analysis of functional changes in ventricular late potentials for risk assessment of ventricular tachycardias after myocardial infarct].

BACKGROUND: Electrophysiological abnormalities during ischaemia and increased heart rate may influence the detection of ventricular late potentials in the surface electrocardiogram. Whether the analysis of functional changes adds information to the risk stratification of patients prone to ventricular tachycardia is unclear. METHODS: We therefore retrospectively investigated 100 selected patients (25 with documented, sustained ventricular tachycardia (< 230/min) ( = VT group), 25 resuscitated from ventricular fibrillation (VF group) and 50 without ventricular arrhythmias (phi VT/VF group)) in the chronic phase after myocardial infarction. Late potential analysis was performed at rest, during atrial pacing at a rate of 100/min and 120/min (n = 60), during and after occlusion of the coronary artery for coronary angioplasty (PTCA) (n = 70), and immediately after maximum exercise using selective signal averaging. RESULTS: At rest in 72% of patients in the VT group, in 32% of the VF group, and in 6% of the phi VT/VF group late potentials could be found. During atrial pacing in 80% of patients in the VT group, in 72% of the VF group, and in 10% of the patients in the phi VT/VF group and during ischaemia because of occluded coronary artery in 86% of patients in and the VT group, 70% of the VF group, and in 20% of the patients of the phi VT/VF group late potentials were present. Immediately after maximum exercise which let both ischaemia and increased heart rate, late potentials were detectable in 92% of patients in the VT group, 80% of the VF group, and in 14% of patients in the phi VT/VF group. Similar results could be achieved by using the Holter-ECG after exact correction of recorder tape speed variations. 62% of patients with only by ischaemia, increased heart rate or exercise provokable late potentials and all patients with preexistent not by PTCA extinguished late potentials developed recurrent ventricular tachycardias during the one year follow-up period. Patients without late potentials (n = 50) and patients with preexistent by PTCA extinguished late potentials (n = 11) had no recurrent ventricular tachycardias. Cycle length of recurrent and clinical tachycardia in patients with preexistent not by PTCA extinguished late potentials (n = 18) were significantly longer than in patients with only provokable late potentials (n = 21). CONCLUSIONS: Analysis of functional changes of ventricular late potentials with exercise or in Holter ECG recordings promises considerable improvement of postinfarction risk stratification especially in patients prone to ventricular fibrillation.

Adult↗
PubMed1998

Plasma endothelin-1 levels in patients with angina pectoris and normal coronary angiograms.

BACKGROUND: Some patients with typical angina and electrocardiographic evidence of ischemia have normal coronary angiograms. These patients have a reduced coronary flow reserve and abnormal endothelium-dependent vasodilator responses; this syndrome is known as microvascular angina. Among endothelium-derived peptides, endothelin-1 (ET-1) is a potent vasoconstrictor and an important modulator of microvascular function. METHODS: Plasma ET-1 was measured in 13 patients with typical angina, instrumental evidence of ischemia, and normal arteriograms and in 20 normal control subjects. RESULTS: Mean concentration of ET-1 was 2.89+/-1.24 pmol/L in patients with angina and normal angiograms and 1.99+/-0.81 pmol/L in normal control subjects (p < 0.02). Plasma levels of ET-1 values were significantly higher in patients with angina, positive exercise test results for ischemia, and normal coronary arteriograms compared with the group of patients with no clinical or instrumental evidence of ischemia. CONCLUSIONS: This is consistent with the hypothesis that in patients with microvascular angina, an endothelial dysfunction in the coronary vascular area caused by impaired endothelium-derived ET-1 could play an active role in the disease process.

Adult↗
PubMed1998

Fast pathway ablation in patients with common atrioventricular nodal reentrant tachycardia and prolonged PR interval during sinus rhythm.

AIMS: This study aimed to clarify the safety and efficacy of selective fast pathway ablation in patients with atrioventricular nodal reentrant tachycardia and a prolonged PR interval during sinus rhythm. Such patients have been reported to have an increased incidence of complete atrioventricular block. METHODS AND RESULTS: In this study, the earliest retrograde atrial activation during atrioventricular nodal reentrant tachycardia and right ventricular stimulation was localized. Fast pathway ablation was then performed in five patients with the common form of atrioventricular nodal reentrant tachycardia and a prolonged PR interval. Three of the five patients had almost incessant atrioventricular nodal reentrant tachycardia. Radiofrequency catheter ablation induced a complete ventriculo-atrial block during right ventricular stimulation in four patients and a marked prolongation of ventriculo-atrial conduction during right ventricular stimulation in one. Non-inducibility of common atrioventricular nodal reentrant tachycardia with and without isoproterenol was achieved in all five patients. The PR interval increased from 254 +/- 53 ms to 276 +/- 48 ms and the atrio-His interval from 172 +/- 46 ms to 192 +/- 45 ms. Second- or third-degree atrioventricular block did not occur during the ablation procedure. During the followup of 19 +/- 20 months none of the patients developed symptoms suggestive of atrioventricular nodal reentrant tachycardia or evidence of second- or third-degree atrioventricular block. CONCLUSION: These data suggest that atrioventricular node (retrograde) fast pathway ablation can apparently be safely performed in patients with common atrioventricular nodal reentrant tachycardia and a prolonged PR interval during sinus rhythm.

Adult↗
PubMed1998

Experience with pectoral versus abdominal implantation of a small defibrillator. A multicenter comparison in 778 patients. European Jewel Investigators.

AIMS: The aim of the study was to examine the results of implanting small sized cardioverter defibrillators in the pectoral as opposed to the abdominal area. Hitherto. owing to the large size of the early defibrillators, the site of implantation had been confined to the abdomen. METHODS: Between 30 March 1993 and 1 November 1994, 778 patients from 63 centres in 14 countries underwent their first device implantation. The study was set up to evaluate the safety and the efficacy of Medtronic models 7219 D, a multi-lead abdominal/pectoral implantable cardioverter defibrillator, and 7219 C, a pectoral single-lead Active Can implantable cardioverter defibrillator. There were 155 abdominal and 623 pectoral implants. Survival data were comparable during a mean follow-up period of 4.0 +/- 4.6 months, with no difference regarding the pectoral placement of single (n = 392) or multi-lead (n = 231) devices. The only significant difference was related to severe lead-related events: 5.3% in the pectoral vs 11.6% the abdominal group (P < 0.05). These events were mainly related to lead dislodgement. Kaplan-Meier estimates showed that both single and multi-lead systems, in either the pectoral or abdominal position, demonstrated a similar severe adverse event-free survival. CONCLUSION: These findings suggest that an implantable cardioverter defibrillator (18 mm thick, 80 cc volume, 129 g weight) can be implanted in the pectoral position without an increase in clinically relevant adverse events compared to abdominal implantation. Pectoral implantation was associated with significantly reduced lead-related severe adverse event rate.

Abdominal Muscles↗
PubMed1998

Pharmacokinetics of meropenem in critically ill patients with acute renal failure treated by continuous hemodiafiltration.

The pharmacokinetics of meropenem were studied in nine anuric critically ill patients treated by continuous venovenous hemodiafiltration. Peak levels after infusion of 1,000 mg over 30 min amounted to 103.2 +/- 45.9 microgram/ml, and trough levels at 12 h were 9.6 +/- 3.8 microgram/ml. A dosage of 1,000 mg of meropenem twice a day provides plasma drug levels covering intermediately susceptible microorganisms. Further reductions of the dosage might be appropriate for highly susceptible bacteria or when renal replacement therapies with lower clearances are applied.

Acute Kidney Injury↗
PubMed1998

'True' atrial tachycardia.

Atrial tachycardia is a rare form of supraventricular tachycardia, accounting for about 10-15% of patients presenting to experienced arrhythmia centres for radiofrequency catheter ablation. The mechanism may be either focal due to increased or abnormal automaticity or triggered activity, or macro re-entrant. When incessant tachycardia is present, tachycardiomyopathy may develop. The efficacy of antiarrhythmic drugs for long-term management of atrial tachycardia is poorly defined, but is probably limited. Class IC or class I agents may be used in re-entrant atrial tachycardia, and verapamil, beta-blockers or class IC agents in the focal type. If these drugs fail, amiodarone may be tried. Experience with radiofrequency catheter ablation to cure atrial tachycardia is limited, but results are very promising with success rates between 80% and 95%, and an acceptably low recurrence and complication rate. Thus, it is likely that, with more experience, radiofrequency catheter ablation will become therapy of first choice for atrial tachycardia when this arrhythmia is not easily and effectively controlled by drugs.

Anti-Arrhythmia Agents↗
PubMed1998

Effects of Class I drugs on atrial fibrillation.

This article reviews our knowledge about the efficacy of Class I antiarrhythmic agents, especially quinidine, propafenone, and flecainide, for pharmacologic conversion of atrial fibrillation to sinus rhythm. When given intravenously or orally for the long term, conversion rates between 50% and 90% are reported for restoration of sinus rhythm as well as for maintenance of sinus rhythm after DC cardioversion. Based on transtelephonic monitoring of arrhythmia recurrences as well as tolerance, Class IC agents appear to be especially effective for suppressing clinical symptoms in patients with paroxysmal atrial fibrillation. For patients who develop atrial fibrillation following coronary artery surgery, Class I agents are the second choice of treatment only. The concept of single oral loading with Class IC agents for conversion of atrial fibrillation appears attractive, but more data are needed before we conclude that it is efficacious as well as safe when given to ambulatory patients. Because all Class I antiarrhythmic agents have the potential for lethal proarrhythmia, the greatest and as yet unsettled issue is safety. Until the advent of large-scale and long-term trials demonstrating the efficacy and safety of Class I agents for the treatment of patients with atrial fibrillation, this strategy, although very popular to suppress frequent and unpleasant symptoms due to atrial fibrillation, cannot be regarded as firmly established.

Anti-Arrhythmia Agents↗
PubMed1998

MIB-1 immunohistometry on Tru-cut biopsies in inflammatory and cirrhotic liver disease.

OBJECTIVE: To use immunohistometry to analyze the MIB-1 immunopositivity of normal liver parenchyma (n = 25) and of different inflammatory and degenerative liver diseases--including nonspecific inflammation (n = 12), toxic-nutritive (alcoholic) inflammation (n = 12), ascending cholangitis (n = 11), chronic-persisting hepatitis (n = 27), chronic-aggressive hepatitis (n = 28) and liver cirrhosis (n = 23). STUDY DESIGN: Immunohistochemical reactions were performed on 3-micron sections of paraffin-embedded Tru-cut biopsies using an indirect peroxidase method. The rate of immunostained cells was determined using the CM-2 TV image analysis system. Twenty viewing fields (0.97 mm2) were measured with 20:1 objective magnification. An average of 2,600 cells were assessed in each case. RESULTS: The values for normal liver tissue were significantly lower as compared with those of all other groups (< .0001 < P < or = .0008). In nonspecific and toxic inflammation and ascending cholangitis, the values did not differ significantly (P > .05). As compared to chronic-persisting viral hepatitis, however, the MIB-1 immunopositivity of nonspecific (P = .0056) and toxic inflammation (P = .0162) was significantly lower. Apart from ascending cholangitis, chronic-aggressive viral hepatitis revealed significantly increased MIB-1 immunopositivity as compared to all other types of inflammation (P < .0001). The MIB-1 values were significantly higher in liver cirrhosis than in the different inflammatory conditions (< .0001 < P < or = .0105) with the exception of chronic-aggressive viral hepatitis. The highest value for normal liver tissue was 0.4%; it was lower than 96% of the values in the different disease groups. Seventy-two percent of the cases with virally induced hepatitis revealed values > 1.5% as compared to only 14% in the other types of inflammation. In chronic-aggressive hepatitis and liver cirrhosis, 71% and 65%, respectively, of the values were > 2%. CONCLUSION: MIB-1 immunohistometry allowed the detection of significantly different proliferative activity among different types of inflammatory and degenerative liver diseases, indicating diagnostic value in histologically inconclusive cases.

Antigens, Nuclear↗
PubMed1997

Fusion and metabolism of plant cells as affected by microgravity.

Plant cell protoplasts derived from leaf tissue of two different tobacco species (Nicotiana tabacum., N. rustica L.) were exposed to short-term (sounding rocket experiments) and long-term (spacelab) microgravity environments in order to study both (electro) cell fusion and cell metabolism during early and later stages of tissue regeneration. The period of exposure to microgravity varied from 10 min (sounding rocket) to 10 d (space shuttle). The process of electro fusion of protoplasts was improved under conditions of microgravity: the time needed to establish close membrane contact between protoplasts (alignment time) was reduced (5 as compared to 15 s under 1 g) and numbers of fusion products between protoplasts of different specific density were increased by a factor of about 10. In addition, viability of fusion products, as shown by the ability to form callus, increased from about 60% to more than 90%. Regenerated fusion products obtained from both sounding-rocket and spacelab experiments showed a wide range of intermediate properties between the two parental plants. This was verified by isozyme analysis and random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR). In order to address potential metabolic responses, more general markers such as the overall energy state (ATP/ADP ratio), the redox charge of the diphosphopyridine nucleotide system (NADH/NAD ratio), and the pool size of fructose-2,6-bisphosphate (Fru 2,6 bisp), a regulator of the balance between glycolysis and gluconeogenesis, were determined. Responses of these parameters were different with regard to short-term and long-term exposure. Shortly after transition to reduced gravitation (sounding rocket) ratios of ATP/ADP exhibited strong fluctuation while the pool size of NAD decreased (indicating an increased NADH/NAD ratio) and that of Fru 2,6 bisp increased. As similar changes can be observed under stress conditions, this response is probably indicative of a metabolic stress compensation. Samples taken for up to 7 d of exposure to microgravity showed the opposite effect. Here, the ratios of ATP/ADP and of NADH/NAD, and the pool size of Fru 2,6 bisp were decreased. We take this an an indication of metabolic relaxation, i.e. decreased metabolic turnover. As rates of protoplast regeneration and cell division were obviously similar to 1-g controls, we conclude that under conditions of microgravity regenerating tobacco mesophyll protoplasts need less metabolic energy for the same effort.

Adenine Nucleotides↗
PubMed1997

ENVIRONMENTAL AUDITING: The Functional Unit in the Life Cycle Inventory Analysis of Degreasing Processes in the Metal-Processing Industry

/ In 1986 degreasing processes in the German metal-processing industry contributed about 70,000 t to the emission of chlorinated C1 and C2 hydrocarbons (trichloroethane, trichloroethene, tetrachloroethene, dichloromethane). Measures aiming at the reduction of toxic emissions and ozone depletion potential (ODP) may possibly lead to a shift of environmental impacts towards higher energy consumption, emission of waste water, and volatile organic compounds (VOC) with photochemical oxidant creation potential (POCP). The present article concerns itself with a life cycle assessment of the three main degreasing processes in order to compare their integral environmental impacts with one another. This is supplemented by presenting the methodology of the life cycle inventory life cycle inventory analysis (LCI). Generally, the applicability of the established LCI method can be shown quite clearly. However, some difficulties arise, especially at the stage of the goal definition, as the use of the process and the functional unit cannot be pinned down as easily and neatly as for most other products. The definition of the use of the process and the functional unit is not as straightforward as for most products. Among the potential functional units identified are the mass of removed impurities, cleaning time, cleaning work, percentage of purity, throughput of parts, loads, mass or surface and virtual coefficients. The mass of removed impurities turned out to be the most suitable parameter for measuring the technical performance of degreasing processes. The article discusses background, purpose, scope, system boundaries, target group, process tree and representativeness of the present study.KEY WORDS: Functional unit; Life cycle assessment; Life cycle inventory analysis; Degreasing processes; Metal processing

Journal Article↗
PubMed1997

Arrhythmogenic right ventricular dysplasia: MR features.

Arrhythmogenic right ventricular dysplasia (ARVD) is a heart disease characterized by a total or partial fat replacement of the myocardium. A total of 30 patients were studied with a suspected diagnosis of ARVD. Clinical criteria used for evaluation of ARVD were: (a) ventricular origin arrhythmias with a left bundle branch block configuration, (b) T-wave inversion in the anterior precordial leads, (c) ventricular kinetic alterations observed using echocardiography and angiography and (d) cardiac failure when there are no pathologies attributable to other heart diseases. All patients had serial EKG and echocardiography tests. One third of patients underwent angiocardiography; 7 of 30 had Holter; 7 of 30 had exercise test just to evaluate the effectiveness of the anti-arrhythmic therapy. All patients underwent MRI examination. The following MRI criteria were used: (a) high-intensity areas indicating the fatty substitution of the myocardium, (b) ectasia of the right ventricular outflow tract, (c) dyskinetic bulges, (d) dilation of the right ventricle and (e) enlargement of the right atrium. The diagnosis of ARVD was classified as highly probable for patients manifesting at least three positive criteria, probable with two positive criteria, dubious with one and negative in the absence of all criteria. Highly probable diagnosis of ARVD was made in 8 patients, probable in 4, dubious in 7 and negative in 11. The MRI technique is very effective in the assessment of ARVD. The MRI criteria may be helpful in the diagnosis of this condition.

Adipose Tissue↗
PubMed1997

Degree of carotid artery stenosis. Comparison of selective and non-selective angiographic findings with surgical specimens.

OBJECTIVE: To compare the degree of vessel narrowing seen on selective and non-selective carotid artery catheter angiograms using criteria set by NASCET and ECST with the results obtained from corresponding surgical specimens. SUBJECTS: In 40 preoperative angiograms (20 non-selective, 20 selective) the 'distal' degree of internal carotid artery (ICA) stenosis according to NASCET criteria and the 'local' degree of stenosis according to ECST criteria was assessed. These data were compared with the 'distal' and 'local' degree of ICA stenosis obtained by measuring the specimens and the diameter of the distal ICA intraoperatively. RESULTS: The median 'local' degree of stenosis was 86.5% in the specimen and 83.5% in the selective angiograms (difference not significant). In non-selective angiography the median 'local' degree of stenosis was 77.5% compared to 84% in the corresponding specimens (P < 0.01). The median 'distal' degree of stenosis in selective angiography was 76.5 versus 75.5% in the specimens (n.s.). The median 'distal' degree of non-selective angiography was 67% compared to 77.5% in the corresponding specimens (P = 0.02). The trend to underestimate high grade stenosis (above 90%) was more pronounced in non-selective than in selective angiography. Medium grade stenosis (60-80%) was slightly overestimated in selective angiography. CONCLUSION: Selective angiography is more accurate in determining the 'true' degree of stenosis in internal carotid artery disease, taking into account a slight overestimation of medium grade stenosis. High grade stenosis is underestimated in both selective and non-selective angiography. These observations extend to both the ECST and NASCET criteria of measuring the degree of stenosis, which differ by about 10%.

Aged↗
PubMed1997

Influence of anodal electrode position on transvenous defibrillation efficacy in humans: a prospective randomized comparison.

Nonthoracotomy lead systems for implantable cardioverter defibrillators (ICDs) have reduced operative mortality and morbidity as compared to epicardial lead systems but are usually associated with higher defibrillation thresholds (DFTs). The purpose of this prospective randomized trial was to investigate if the second defibrillation electrode in the left subclavian vein can increase defibrillation efficacy and decrease DFT as compared to the superior vena cava (SVC) position in nonthoracotomy lead systems for ICDs. Seventeen patients (mean age: 49.9 +/- 11.3 years, mean ejection fraction: 46.1% +/- 15.8%) were implanted with an investigational unipolar electrode (Medtronic 13001) used as the defibrillation anode. DFT testing was started in the SVC (n = 10, group A) or the left subclavian vein (n = 7, group B), and repeated in the alternative position starting at the DFT of the initial position. Fifteen patients were eligible for analysis (group A: n = 9, group B: n = 6). With the electrode in the SVC, ventricular fibrillation could be successfully terminated in 9 out of 15 patients (60%). In the left subclavian vein the success rate was 100% (P < 0.01). Mean DFT in the SVC was 13.0 +/- 5.2 J and in the left subclavian vein 10.2 +/- 4.9 J. DFTs in the left subclavian vein were either lower (group A: n = 5/9, group B: n = 5/6) or equal to the results in the SVC position (P < 0.001). Thus, the left subclavian vein appears to be a superior alternative for positioning of the defibrillation anode as compared to the SVC for nonthoracotomy lead systems using two separate leads.

Defibrillators, Implantable↗