Innovative Techniques for Placement of Implantable Cardioverter‐Defibrillator Leads in Patients with Limited Venous Access to the Heart

Abstract

Many factors may prohibit transvenous ICD lead placement. Nontraditional surgical placement of subcutaneous ICD leads on the pericardium or the use of a transatrial approach can be effective techniques in these patients. These procedures can be performed at low risk to the patient with excellent defibrillation thresholds.

Interventional Electrophysiology in Patients With Congenital Heart Disease

“…Numerous configurations of coils and patches have been described for shock delivery (Figure 8) when epicardial implantation is the only option. 108,109 Defibrillation thresholds measured in CHD patients with either transvenous or epicardial systems are similar to those obtained in patients with conventional cardiac anatomy. Long-term data on defibrillator performance suggest appropriate shock therapy in Ϸ30% of CHD patients over 5 years of follow-up, 35 with inappropriate shocks in 25% (mostly for sinus tachycardia) and lead failure (requiring revision) in 21%.…”

A computer modeling tool for comparing novel ICD electrode orientations in children and adults

“…[6][7][8][9] In these patient populations, a variety of innovative approaches to ICD implantation have been reported, including subcutaneous, epicardial and caval electrode placements and/or abdominal can implants (Figure 1). [7][8][9][10][11][12] Employing ad hoc adaptations of existing ICD components, these approaches attempt to minimize system invasiveness, incorporate patient specific options to adapt to complex anatomy, and achieve low defibrillation thresholds. Assumptions of efficacy are based on extrapolation of data from the use of subcutaneous arrays in adults, limited animal research and post-implantation assessment of defibrillation thresholds.…”

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].…”