Subcutaneous Array to Transvenous Proximal Coil Defibrillation as a Solution to High Defibrillation Thresholds with Implantable Cardioverter Defibrillator Distal Coil Failure

Avitall, Boaz; Oza, Saumil R.; Gonzalez, Rose C.; Avery, Robert

doi:10.1046/j.1540-8167.2003.02470.x

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…Implanting subcutaneous arrays is among the alternatives to improve DFT by redirecting the shock vectors. 8 However, its utility is limited by higher infection risks, patient’s discomfort, and lead fractures. Moreover, subcutaneous arrays are not compatible with right-sided generators due to the misalignment of vectors.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Single-center Experience of Azygos Vein Defibrillator Lead Insertion

YANG¹,

SHETTY²,

KORANNE³

et al. 2022

J Innov Cardiac Rhythm Manage.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review and Single-center Experience of Azygos Vein Defibrillator Lead Insertion

YANG¹,

SHETTY²,

KORANNE³

et al. 2022

J Innov Cardiac Rhythm Manage.

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“…However, in a small percentage of patients, invasive treatment options are necessary . For this population, multiple alternative methods to lower the DFT have been reported, including the implantation of an extra coil in the superior vena cava (SVC), azygos vein , or the use of a subcutaneous array …”

Section: Discussionmentioning

confidence: 99%

“…Bailout alternatives have been proposed in this setting. Such strategies include reassessment of the right ventricular (RV) lead position, alteration of the shock waveform, implantation of subcutaneous arrays, independent positioning of the proximal coil of a dual‐coil system in the left subclavian vein, or placement of epicardial patches . Placement of a coil into the coronary sinus (CS) lead can also result in substantial reductions in the mean DFT.…”

Section: Introductionmentioning

confidence: 99%

Coronary vein defibrillator coil placement in patients with high defibrillation thresholds

Rodríguez‐Mañero

Kreidieh

Ibarra-Cortez

et al. 2018

Journal of Arrhythmia

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BackgroundElevated defibrillation threshold (DFT) occurs in 2%‐6% of patients undergoing implantable cardioverter defibrillator (ICD) implantation. Adding a defibrillation coil in the coronary sinus (CS) or its branches can result in substantial reductions in the mean DFT. However, data regarding acute success and long‐term stability remain lacking. We report our experience with this bailout strategy.MethodsPatients with elevated DFT at implantation (safety margin at implantation <10 J) and those with failed ICD shocks for ventricular arrhythmias (VA) referred for high DFT underwent placement of an additional defibrillation coil in the CS. DFT testing was performed at the completion of the implantation procedure. External potentially reversible factors were excluded. High‐output devices were systematically used.ResultsFour patients with high DFT at implantation and two with several failed shock attempts underwent placement of a defibrillation coil in the CS. Mean age was 41.8 (23‐78). They presented a mean LVEF of 21% (15‐30), QRS‐complex duration of 109.8 milliseconds (87‐168), body surface area of 1.96 m2 (1.45‐2.58), and a mean R wave of 16.3 mV (8‐27). Defibrillation coil implantation in the CS (final shocking configuration of right ventricle as anode and left ventricle (LV) plus can as cathode) was associated with successful DFT testing in all. Three patients had a concomitant LV lead for biventricular pacing. During a mean follow‐up of 54.67 months (10‐118), two patients experienced successful ICD shocks for VA (one of them also presented inappropriate shocks because of the fast conducting atrial fibrillation).ConclusionsPositioning of a defibrillation coil in the CS can result in a substantial reduction in mean DFT and associates with optimal long‐term stability.

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“…The additional use of a subcutaneous defibrillation lead finally resulted in an acceptable DFT. 21,22 Due to the initial high DFT using the extracardiac technique a different safety margin of <15 J was defined. Using two transvenous electrodes subcutaneously might have been an alternative approach in this patient.…”

Section: Discussionmentioning

confidence: 99%

ICD Implantation in Infants and Small Children: The Extracardiac Technique

Kriebel¹,

Ruschewski

Gonzalez³

et al. 2006

Pacing Clinical Electrophis

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Subcutaneous Array to Transvenous Proximal Coil Defibrillation as a Solution to High Defibrillation Thresholds with Implantable Cardioverter Defibrillator Distal Coil Failure

Abstract: Implantation of a subcutaneous array to improve the defibrillation threshold of an existing transvenous defibrillation lead system without the need for lead extraction is discussed. (J Cardiovasc Electrophysiol, Vol. 14, pp. 314‐315, March 2003)

Cited by 7 publications

References 7 publications

A Systematic Review and Single-center Experience of Azygos Vein Defibrillator Lead Insertion

A Systematic Review and Single-center Experience of Azygos Vein Defibrillator Lead Insertion

Coronary vein defibrillator coil placement in patients with high defibrillation thresholds

ICD Implantation in Infants and Small Children: The Extracardiac Technique

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