An Epicardial Subxiphoid Implantable Defibrillator Lead:

Abstract

A single epicardial implantable lead using the subxiphoid approach is described in this article. It consists of a single halo-shaped coil that is implanted under the inferior surface of the heart, including the right and left inferior ventricular surfaces. It has been implanted in four patients who could not be defibrillated with a transvenous system, even with the adjunct use of subcutaneous leads or left chest wall patch. Three of the patients had progressive heart failure due to ischemic myocardiopathy; the fourth patient had a dilated idiopathic myocardiopathy. The approach is simple and appears to be effective due to its ability to encompass the left and right ventricles. This vector seems to significantly lower the threshold for defibrillation, and may offer substantial benefit in the setting of high defibrillation thresholds with conventional leads, or when conventional systems are inadequate to achieve consistent defibrillation.

Implantation of Looped Epicardial Cardioverter Defibrillator Coil on the Surface of the Right Ventricular Outflow Tract

“…4 Although many creative configurations had been defined in order to set up the most effective and reliable system, our configuration seems to involve one of the shortest distances between the active can and the high voltage defibrillation coil. [4][5][6][7][8][9][10][11] We believe that the vector distance plays an important role in the production of low defibrillation energy. Berul et al had worked on animal models and they attributed the high DFT values to the increased cardiac mass and the body shape of the different species.…”

“…Even though the high DFTs may simply be attributed to the patient's underlying electrical stability, it may also result from the distance between the active can and the defibrillating coil . Although many creative configurations had been defined in order to set up the most effective and reliable system, our configuration seems to involve one of the shortest distances between the active can and the high voltage defibrillation coil . We believe that the vector distance plays an important role in the production of low defibrillation energy.…”

A Novel Approach to Transvenous Dual‐Chamber Pacing Lead Placement and Cardiac Defibrillator Implantation After Tricuspid Valve Replacement

“…Recently, clinicians have reported placing subcutaneous defibrillating coil leads in the pericardial space via a subxiphoid approach to avoid the need for epicardial patches in patients with a high defibrillation threshold, 9 or to avoid transvenous defibrillating coil or epicardial patch in the pediatric and congenital heart disease patient 10 . In addition, Stephenson and associates 11 have published a retrospective review of novel ICD configurations for implanting ICDs without transvenous coil leads or epicardial patches in this population 11 .…”

Cardiac implantable electronic devices in end-stage renal disease patients: preservation of central venous circulation

“…The intravascular location of the CIEDs makes the leads vulnerable to bacterial seeding during HD [31]. In recent years, we have also observed an evolution of implantation techniques of epicardial and subcutaneous CIEDs, making it accessible to patients in whom the traditional transvenous implantation could be associated with high complication rates [32][33][34][35][36].…”