Usefulness of lead repositioning from left to right sternal border for a patient with subcutaneous implantable cardioverter defibrillator showing high defibrillation threshold

Wakabayashi, Yasushi; Mitsuhashi, Takeshi; Fujita, Hideo; Momomura, Shin‐ichi

doi:10.1002/joa3.12145

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…Several case reports demonstrated successful defibrillation with 65J in ACHD patients with right-sided S-ICD lead placement. [26][27][28] Theoretically, right-sided S-ICD lead placement can be more effective in arrhythmia termination than left-sided S-ICD lead placement, because of a more favorable S-ICD electric lead field, encompassing the whole heart (Figure 1). An in silico study reported a lower defibrillation threshold for right-sided than for left-sided S-ICD lead placement.…”

Section: Nearly Half Of the Contemporary Achd Population Is Ineligible For S-icdmentioning

confidence: 99%

Eligibility for subcutaneous implantable cardioverter-defibrillator in congenital heart disease

et al. 2020

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Section: Nearly Half Of the Contemporary Achd Population Is Ineligible For S-icdmentioning

confidence: 99%

Eligibility for subcutaneous implantable cardioverter-defibrillator in congenital heart disease

et al. 2020

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“…Our findings including the pathological analysis suggested that the frequent S-ICD therapies caused a critical inflammation and fibrosis of the subcutaneous tissue around the S-ICD can and lead to an increased DFT. Wakabayashi et al reported the usefulness of lead repositioning from the left to the right sternal border if patients with an S-ICD have a high DFT during the implantation procedure [12]. To the best of the authors' knowledge, this is the first report to present a Brugada syndrome case who required a device Fig.…”

Section: Discussionmentioning

confidence: 78%

Refractoriness to subcutaneous implantable cardioverter defibrillator after frequent therapies for ventricular fibrillation storms in a Brugada syndrome case

Nakao

Suenari

Yamashiro

et al. 2020

BMC Cardiovasc Disord

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Background: The subcutaneous implantable cardioverter defibrillator (S-ICD) is an alternative to the transvenous implantable cardioverter defibrillator for the prevention of sudden cardiac death. Here, we report a rare case of refractoriness to an S-ICD after frequent therapies for ventricular fibrillation (VF) storms. Case presentation: A 24-year-old man underwent a bout of syncope with vomiting and incontinence at home. He was brought to the emergency room and was witnessed to spontaneously go into VF successfully converted by external defibrillation. Previously, he was diagnosed with a type I Brugada electrocardiogram pattern by a pilsicainide administration test in another hospital. Although he had a family history of sudden cardiac death in 3 relatives, including his brother, he was followed closely without any therapies because he had never had an episode of syncope. He was implanted with an S-ICD without any trouble. Seven months later, frequent S-ICD shocks for VF storms occurred. His VF was controlled by using intravenous amiodarone, which was converted to an oral preparation. However, his VF recurred after another 2 months. The analysis of his S-ICD data revealed that 4 consecutive shock deliveries could not terminate his VF and the final shock delivered could fortunately terminate it because of a high defibrillation threshold test (DFT) due to an increasing shock impedance (64 to 90 Ω). First, we performed an epicardial Brugada syndrome ablation and subsequently replaced and repositioned the S-ICD lead from a left to a right parasternal site. After the re-implantation of the S-ICD, the DFT test improved to within normal range. According to the pathological analysis, infiltration of inflammatory cells and extensive fibrosis were confirmed in the subcutaneous tissue around the shock lead and S-ICD body. Conclusion: Frequent S-ICD shocks for VF storms might cause various pathological changes around the device and lead to a high DFT.

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Eligibility for Subcutaneous Implantable Cardioverter Defibrillator in Congenital Heart Disease

Wang

Javadekar

Rajagopalan

et al. 2019

Preprint

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Background: The goals of this study were: assess left-and right-sided subcutaneous implantable cardioverter-defibrillator (SICD) eligibility in adult congenital heart disease (ACHD) patients, use machine learning to predict SICD eligibility in ACHD patients, and transform 12-lead ECG to S-ICD 3-lead ECG, and vice versa. Methods: ACHD outpatients (n=101; age 42±14 y; 52% female; 85% white; left ventricular ejection fraction (LVEF) 56±9%) were enrolled in a prospective study. Supine and standing 12-lead ECG was recorded simultaneously with a right- and left-sided S-ICD 3-lead ECG. Peak-to-peak QRS and T amplitudes, RR, PR, QT, QTc, QRS intervals, Tmax, and R/Tmax (31 predictor variables) were tested. Model selection, training, and testing were performed using supine ECG datasets. Validation was performed using standing ECG datasets and out-of-sample non-ACHD population (n=68; age 54±16 y; 54% female; 94% white; LVEF 61±8%). Results: A 40% of participants were ineligible for S-ICD. Tetralogy of Fallot patients passed right-sided screening (57%) more often than left-sided (21%; McNemar's χ2 P=0.025). The ridge model demonstrated the best cross-validation function. Validation of the ridge models was satisfactory for standing left-sided [ROC AUC 0.687 (95%CI 0.582-0.791)] and right-sided [ROC AUC 0.655(95%CI 0.549-0.762)] SICD eligibility prediction. Out-of-sample validation in the non-ACHD population yielded a 100% sensitivity of the pre-selected threshold for the elastic net model. Validation of the transformation matrices showed satisfactory agreement (<0.1 mV difference). Conclusion: Nearly half of the contemporary ACHD population is ineligible for S-ICD. Machine-learning prediction of SICD eligibility can be used for screening of SICD candidates. Clinical Trial Registration: URL: www.clinicaltrials.gov Unique identifier: NCT03209726

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Usefulness of lead repositioning from left to right sternal border for a patient with subcutaneous implantable cardioverter defibrillator showing high defibrillation threshold

Cited by 3 publications

References 5 publications

Eligibility for subcutaneous implantable cardioverter-defibrillator in congenital heart disease

Eligibility for subcutaneous implantable cardioverter-defibrillator in congenital heart disease

Refractoriness to subcutaneous implantable cardioverter defibrillator after frequent therapies for ventricular fibrillation storms in a Brugada syndrome case

Eligibility for Subcutaneous Implantable Cardioverter Defibrillator in Congenital Heart Disease

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