Distal Right Ventricular Coil Position Reduces Defibrillation Thresholds

Rashba, Eric J.; Bonner, Matthew; Wilson, John H.; Shorofsky, Stephen R.; Peters, Robert W.; Gold, Michael R.

doi:10.1046/j.1540-8167.2003.03205.x

Cited by 14 publications

(8 citation statements)

References 26 publications

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“…Repositioning of the RV lead is a consideration if the initial lead location is not ideal. A distal shock coil far from apex may elevate DFTs [41,42], and implanting the RV lead near septum and apex may lower DFTs [43][44][45]. Adding a shock coil in the middle cardiac vein [46][47][48][49][50] or azygous vein or implanting a subcutaneous array electrode [51][52][53][54] may be a more successful strategy for low DSM patients who failed to convert ventricular fibrillation with maximum delivered energy, especially in right-sided implant patients.…”

Section: Discussionmentioning

confidence: 99%

Incidence and clinical predictors of low defibrillation safety margin at time of implantable defibrillator implantation

Cheng

Turakhia

et al. 2012

J Interv Card Electrophysiol

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Section: Discussionmentioning

confidence: 99%

Incidence and clinical predictors of low defibrillation safety margin at time of implantable defibrillator implantation

Cheng

Turakhia

et al. 2012

J Interv Card Electrophysiol

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“…Satisfactory RV lead positioning is crucial to optimize DFTs. Rashba et al demonstrated that a very distal position of the coil in the RV was superior to a more proximal site in the body of the RV 2 . Thus positioning of the RV coil on the septum rather than at the apex may be disadvantageous to DFTs.…”

Section: Discussionmentioning

confidence: 99%

A Biventricular ICD System with Biventricular Defibrillation

Spurrell

Gandhi

Rinaldi

2006

Pacing Clinical Electrophis

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We describe the case of a 59-year-old gentleman with severe dilated cardiomyopathy requiring implantation of a dual-chamber biventricular implantable cardioverter-defibrillator (ICD). High defibrillation thresholds (DFT) were encountered at implant with an inadequate defibrillation safety margin. Testing of all possible shock vectors/polarities with and without the SVC coil and optimization of the distal RV coil position all proved inadequate. A satisfactory defibrillation safety margin was achieved following placement of a second lead in the coronary sinus to enable biventricular defibrillation. This case highlights an additional strategy for combating high DFTs and is an option even in dual-chamber biventricular ICD systems.

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“…Furthermore, ''optimal'' placement of the SVC coil is limited due to varying right heart dimension, and the fixed inter-coil spacing in current dual-coil defibrillation lead systems [47][48][49][50].…”

Section: Optimal Placement Of the Superior Vena Cava (Svc) Coil In Dumentioning

confidence: 99%

Dual- versus single-coil implantable defibrillator leads: review of the literature

Neuzner

Carlsson

2012

Clin Res Cardiol

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The preferred use of dual-coil implantable defibrillator lead systems in current implantable defibrillator therapy is likely based on data showing statistically lower defibrillation thresholds with dual-coil defibrillator lead systems. The following review will summarize the clinical data for dual- versus single-coil defibrillator leads in the left and right pectoral implant locations, and will then discuss the clinical implications of single- versus dual-coil usage for atrial defibrillation, venous complications, and the risks associated with lead extraction. It will be noted that there are no comparative clinical studies on the use and outcomes of single- versus dual-coil lead systems in implantable defibrillator therapy over a long-term follow-up. The limited long-term reliability of defibrillator leads is a major concern in implantable defibrillator and cardiac resynchronization therapy. A simpler single-coil defibrillator lead system may improve the long-term performance of implanted leads. Furthermore, the superior vena cava coil is suspected to increase interventional risk in transvenous lead extraction. Therefore, the need for objective data on extractions and complications will be emphasized.

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Distal Right Ventricular Coil Position Reduces Defibrillation Thresholds

Abstract: DFTs are significantly reduced with the distal RV configuration compared to the proximal RV configuration. Defibrillation leads should be designed with the shortest tip to coil distance that can be achieved without compromising ventricular fibrillation sensing.

Cited by 14 publications

References 26 publications

Incidence and clinical predictors of low defibrillation safety margin at time of implantable defibrillator implantation

Incidence and clinical predictors of low defibrillation safety margin at time of implantable defibrillator implantation

A Biventricular ICD System with Biventricular Defibrillation

Dual- versus single-coil implantable defibrillator leads: review of the literature

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