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Rodríguez‐Mañero M, Kreidieh B, Ibarra‐Cortez SH, Álvarez P, Schurmann P, Dave AS, Valderrábano M. Coronary vein defibrillator coil placement in patients with high defibrillation thresholds. J Arrhythm 2019; 35:79-85. [PMID: 30805047 PMCID: PMC6373648 DOI: 10.1002/joa3.12136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/23/2018] [Accepted: 09/05/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Elevated 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. METHODS Patients 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. RESULTS Four 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). CONCLUSIONS Positioning 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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Affiliation(s)
- Moisés Rodríguez‐Mañero
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
- Cardiology DepartmentComplejo Hospital Universitario de SantiagoSantiago de CompostelaSpain
- IDIS (Instituto para el Desarrollo e Integración de la Salud)Santiago de CompostelaSpain
- CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares)Santiago de CompostelaSpain
| | - Bahij Kreidieh
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Sergio H. Ibarra‐Cortez
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Paulino Álvarez
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Paul Schurmann
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Amish S. Dave
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
| | - Miguel Valderrábano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research InstituteThe Methodist HospitalHoustonTexas
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Single and dual coil shock efficacy and predictors of shock failure in patients with modern implantable cardioverter defibrillators—a single-center paired randomized study. J Interv Card Electrophysiol 2019; 54:65-72. [DOI: 10.1007/s10840-018-0443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
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Almehmadi F, Manlucu J. Should Single-Coil Implantable Cardioverter Defibrillator Leads Be Used in all Patients? Card Electrophysiol Clin 2018; 10:59-66. [PMID: 29428142 DOI: 10.1016/j.ccep.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The historical preference for dual-coil implantable cardioverter defibrillator leads stems from high defibrillation thresholds associated with old device platforms. The high safety margins generated by contemporary devices have rendered the modest difference in defibrillation efficacy between single- and dual-coil leads clinically insignificant. Cohort data demonstrating worse lead extraction outcomes and higher all-cause mortality have brought the incremental utility of an superior vena cava coil into question. This article summarizes the current literature and re-evaluates the utility of dual-coil leads in the context of modern device technology.
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Affiliation(s)
- Fahad Almehmadi
- Division of Cardiology, Department of Medicine, Western University, PO Box 5339, 339 Windermere Road, Room B6-127, London, Ontario N6A 5A5, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Department of Medicine, Western University, PO Box 5339, 339 Windermere Road, Room B6-127, London, Ontario N6A 5A5, Canada.
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Malhotra R, Patel S, Ramchand T, Al Nimri O. Higher defibrillation threshold in methamphetamine cardiomyopathy patients with implantable cardioverter-defibrillator. Indian Pacing Electrophysiol J 2017; 17:167-170. [PMID: 29231820 PMCID: PMC5784601 DOI: 10.1016/j.ipej.2017.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/03/2017] [Accepted: 07/08/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Identification of patients with an increased risk of high defibrillation thresholds (DFTs) is important in planning implantable cardioverter-defibrillator (ICD) procedures. Clinical observations have suggested that patients with methamphetamine cardiomyopathy (MACMP) have significantly elevated defibrillation thresholds. We hypothesized that MACMP patients would have higher DFT thresholds than controls and would require procedural changes during ICD implantation to accommodate higher thresholds. METHODS We identified consecutive patients with MACMP undergoing ICD implantation at the academic center from 2003 to 2007. We then compared DFTs against age-and sex-matched controls. RESULTS The MACMP (n = 10) group showed significantly increased DFT thresholds (23.7 ± 6.7 J) compared with age and sex-matched controls (14.5 ± 4.6 J, p < 0.005). Additionally, patients with MACMP had evidence of more severe congestive heart failure, with increased B-type natrieutic protein (BNP) levels (1173 ± 784 vs 260 ± 349, p = 0.02) and decreased left ventricular ejection fraction (LVEF) (17.8 ± 9.4 vs 35.9 ± 15.2, p = 0.02). MACMP patients required high output devices than controls (50% versus 0%, p = 0.03). Differences between groups remained significant despite adjusting for LVEF. CONCLUSIONS Planning for ICD implantation should take into consideration a history of methamphetamine abuse, mandating DFT testing and empiric consideration of high output devices for such patients.
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Affiliation(s)
- Rakesh Malhotra
- Department of Medicine, Rutgers New Jersey Medical School, United States.
| | - Shyam Patel
- Department of Medicine, Rutgers New Jersey Medical School, United States
| | - Tekchand Ramchand
- Department of Medicine, Rutgers New Jersey Medical School, United States
| | - Omar Al Nimri
- Department of Medicine, Vanderbilt University Medical Center, United States
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Bänsch D, Bonnemeier H, Brandt J, Bode F, Svendsen JH, Ritter O, Aring J, Gutleben KJ, Schneider R, Felk A, Hauser T, Buchholz A, Hindricks G, Wegscheider K. Shock efficacy of single and dual coil electrodes—new insights from the NORDIC ICD Trial. Europace 2017; 20:971-978. [DOI: 10.1093/europace/eux075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/28/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dietmar Bänsch
- Heart Center Rostock, Department of Internal Medicine I, Divisions of Cardiology, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Hendrik Bonnemeier
- Department of Internal Medicine III Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straβe 3, 24105 Kiel, Germany
| | - Johan Brandt
- Arrhythmia Department, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Frank Bode
- Medical Clinic II Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Jesper Hastrup Svendsen
- Heart Center, Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen and Danish Arrhythmia Research Centre, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Oliver Ritter
- Department Cardiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Johannes Aring
- Department of Internal Medicine I, Divisions of Cardiology, Internal and Intersive Care Medicine, Hospital Leverkusen, Am Gesundheitspark 11, 51375 Leverkusen, Germany
| | - Klaus-Jürgen Gutleben
- Heart and Diabetes Center North Rhine-Westphalia, University Clinic, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Ralph Schneider
- Heart Center Rostock, Department of Internal Medicine I, Divisions of Cardiology, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | | | - Tino Hauser
- Biotronik, Woermannkehre 1, 12359 Berlin, Germany
| | - Anika Buchholz
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Kumar P, Baker M, Gehi AK. Comparison of Single-Coil and Dual-Coil Implantable Defibrillators. JACC Clin Electrophysiol 2017; 3:12-19. [DOI: 10.1016/j.jacep.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022]
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Larsen JM, Hjortshøj SP, Nielsen JC, Johansen JB, Petersen HH, Haarbo J, Johansen MB, Margrethe Thøgersen A. Single-coil and dual-coil defibrillator leads and association with clinical outcomes in a complete Danish nationwide ICD cohort. Heart Rhythm 2016; 13:706-12. [DOI: 10.1016/j.hrthm.2015.11.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Indexed: 11/29/2022]
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Okamura H, Friedman PA, Inoue Y, Noda T, Aiba T, Yasuda S, Ogawa H, Kamakura S, Kusano K, Espinosa RE. Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy. Circ J 2016; 80:2199-203. [DOI: 10.1253/circj.cj-16-0428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Division of Cardiovascular Diseases, Mayo Clinic
| | | | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Uyguanco ER, Berger A, Budzikowski AS, Gunsburg M, Kassotis J. Management of high defibrillation threshold. Expert Rev Cardiovasc Ther 2014; 6:1237-48. [DOI: 10.1586/14779072.6.9.1237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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BAROLD SS, HERWEG BENGT. Are Dual-Coil ICD Leads Obsolete? Pacing Clin Electrophysiol 2013; 36:923-5. [DOI: 10.1111/pace.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 03/30/2013] [Accepted: 04/10/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S. S. BAROLD
- From the Florida Heart Rhythm Institute; Tampa; Florida
| | - BENGT HERWEG
- From the Florida Heart Rhythm Institute; Tampa; Florida
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Kutyifa V, Huth Ruwald AC, Aktas MK, Jons C, McNitt S, Polonsky B, Geller L, Merkely B, Moss AJ, Zareba W, Bloch Thomsen PE. Clinical impact, safety, and efficacy of single- versus dual-coil ICD leads in MADIT-CRT. J Cardiovasc Electrophysiol 2013; 24:1246-52. [PMID: 23889863 DOI: 10.1111/jce.12219] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 05/26/2013] [Accepted: 05/28/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current data on efficacy, safety and impact on clinical outcome of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads are limited and contradictory. METHODS Defibrillation threshold (DFT) at implantation and first shock efficacy were compared in patients implanted with single- versus dual-coil ICD leads in MADIT-CRT. The risk for atrial tachyarrhythmias and all-cause mortality were evaluated. Short- (< 30 days after the implantation) and long-term (throughout the entire study duration) complications were assessed. RESULTS Patients with dual-coil ICD leads had significantly lower DFTs compared to patients with single-coil ICD leads (17.6 ± 5.8 J vs 19.4 ± 6.1 J, P < 0.001). First shock efficacy was similar among patients with dual and single-coil ICD leads (89.6% vs 92.3%, P = 1.00). When comparing patients with dual versus single-coil ICD leads, there was no difference in the risk of atrial tachyarrhythmias (HR = 1.57, 95% CI: 0.81-3.02, P = 0.18), or in the risk of all-cause mortality (HR = 1.10, 95% CI: 0.58-2.07, P = 0.77). Patients implanted with single- or dual-coil ICD lead had similar short and long-term complication rates (short-term HR = 0.96, 95% CI: 0.56-1.65, P = 0.88, long-term procedure-related HR = 0.99, 95% CI: 0.62-1.59, P = 1.00, long-term ICD lead related: HR = 1.2, 95% CI: 0.5-2.9, P = 0.68) during the mean follow-up of 3.3 years. CONCLUSIONS Patients with single-coil ICD leads have slightly higher DFTs compared to those with dual-coil leads, but the efficacy, safety, and clinical impact on atrial tachyarrhythmias, and mortality is similar. Implantation of single-coil ICD leads may be favorable in most patients.
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Affiliation(s)
- Valentina Kutyifa
- University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, NY, USA; Semmelweis University Heart Center, Budapest, Hungary
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Bastian D, Kracker S, Pauschinger M, Göhl K. ICD implantation without intraoperative testing does not increase the rate of system modifications and does not impair defibrillation efficacy tested in follow-up. Herzschrittmacherther Elektrophysiol 2013; 24:125-30. [PMID: 23744101 DOI: 10.1007/s00399-013-0267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 04/28/2013] [Indexed: 11/24/2022]
Abstract
AIM The need for implantable cardioverter-defibrillator (ICD) defibrillation testing (DT) and subsequent intraoperative system modifications is discussed controversially. The study's goal was to prove that consequent abdication of intraoperative DT does not impair defibrillation efficacy and does not increase the rate of postoperative system revisions. METHODS In a prospective single-center observational study, 609 out of 648 consecutive patients underwent transvenous ICD implantation (left-sided, active can, dual coil lead, and biphasic shock waveform) waiving intraoperative DT. Defibrillation efficacy was validated prior to hospital discharge (PHD) by applying two 10 J safety margin (SM) shocks. RESULTS Following "schockless" implantation 580 out of 609 patients (95.2 %) met a 10 J SM with default programming. Shock path reversal provided 10 J SM in 13 out of 29 cases with initially failed DT. In four patients (0.7 %) maximum energy shocks were ineffective. There was no morbidity or mortality related to DT. The total rate of surgical ICD revisions was 1.8 %. CONCLUSION Routine ICD implantation without intraoperative DT does not lead to an increased rate of postoperative system modifications and does not decrease defibrillation efficacy as tested PHD.
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Affiliation(s)
- Dirk Bastian
- Division of Cardiology and Electrophysiology, Medizinische Klinik 8, Klinikum Nürnberg Süd, Breslauer Str. 201, 90471, Nuremberg, Germany.
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How to Manage a High Defibrillation Threshold in ICD Patients: and Does it Really Matter? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:497-505. [DOI: 10.1007/s11936-013-0244-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, DeLurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL, Anand I, Blomström-Lundqvist C, Boehmer JP, Calkins H, Cazeau S, Delgado V, Estes NAM, Haines D, Kusumoto F, Leyva P, Ruschitzka F, Stevenson LW, Torp-Pedersen CT. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Europace 2013; 14:1236-86. [PMID: 22930717 DOI: 10.1093/europace/eus222] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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GOLD MICHAELR, VAL-MEJIAS JESUS, CUOCO FRANK, SIDDIQUI MUKKARAM. Comparison of Fixed Tilt and Tuned Defibrillation Waveforms: The PROMISE Study. J Cardiovasc Electrophysiol 2012; 24:323-7. [DOI: 10.1111/jce.12041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, Delurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm 2012; 9:1524-76. [PMID: 22939223 DOI: 10.1016/j.hrthm.2012.07.025] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 11/30/2022]
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Neuzner J, Carlsson J. Dual- versus single-coil implantable defibrillator leads: review of the literature. Clin Res Cardiol 2012; 101:239-45. [DOI: 10.1007/s00392-011-0407-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 12/23/2011] [Indexed: 11/25/2022]
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Kolandaivelu A, Jayanti V, Halperin HR, Berger RD. Switchable Faraday shielding with application to reducing the pain of internal cardiac defibrillation while permitting external defibrillation. IEEE Trans Biomed Eng 2011; 59:409-16. [PMID: 22042127 DOI: 10.1109/tbme.2011.2173687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Switchable Faraday shielding is desirable in situations where electric field shielding is required at certain times and undesirable at other times. In this study, electrostatic finite element modeling was used to assess the effect of different shield geometries on the leakage of an internally applied field and penetration of an externally applied field. "Switching OFF" the shield by electrically disconnecting shield faces from each other was shown to significantly increase external field penetration. Applying this model to defibrillation, we looked at the effect of spacing and size of shield panels to maximize the ability to deliver an external defibrillation shock to the heart when shield panels are disconnected while providing acceptably low leakage of internal defibrillation shocks to avoid painful skeletal muscle capture when shield panels are connected. This analysis may be useful for designing internal defibrillator electrodes that preserve the efficacy of internal and external defibrillation while avoiding the significant morbidity associated with painful defibrillator shocks. Similar analysis could also guide optimizing the switchable Faraday shielding concept for other applications.
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Affiliation(s)
- Aravindan Kolandaivelu
- Cardiology Division, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Kroll MW. To the Editor: End of the apex era? Heart Rhythm 2011; 8:e9-10. [DOI: 10.1016/j.hrthm.2011.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Indexed: 10/18/2022]
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Shetty AK, Behan MWH, Bostock J, Rinaldi CA. Device therapy for the management of cardiac tachyarrhythmias. Expert Rev Cardiovasc Ther 2010; 8:1257-66. [PMID: 20828348 DOI: 10.1586/erc.10.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Implantation of devices that can terminate cardiac arrhythmias has increased rapidly over recent years. This article looks at the evidence base for using such devices in the primary and secondary prevention of sudden arrhythmic death, discusses who should have a device and examines the issues surrounding implantation. Recent advances in technology and the future direction of therapy are also reviewed.
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Affiliation(s)
- Anoop K Shetty
- Guys and St Thomas' Hospital NHS Foundation Trust, London, UK.
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Novel intravascular defibrillator: defibrillation thresholds of intravascular cardioverter-defibrillator compared to conventional implantable cardioverter-defibrillator in a canine model. Heart Rhythm 2010; 8:288-92. [PMID: 21034853 DOI: 10.1016/j.hrthm.2010.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 10/20/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND An intravascular, percutaneously placed implantable defibrillator (InnerPulse percutaneous intravascular cardioverter-defibrillator [PICD]) with a right ventricular (RV) single-coil lead and titanium electrodes in the superior vena cava (SVC) and the inferior vena cava (IVC) has been developed. OBJECTIVE The purpose of this study was to compare defibrillation thresholds (DFTs) of the PICD to those of a conventional implantable cardioverter-defibrillator (ICD) in canines. METHODS Eight Bluetick hounds were randomized to initial placement of either a PICD or a conventional ICD. For PICD DFTs, a single-coil RV defibrillator lead was placed in the RV apex, and the device was positioned in the venous vasculature with electrodes in the SVC and IVC. With the conventional ICD, an RV lead was placed in the RV apex and an SVC coil was appropriately positioned. The ICD active can (AC) was implanted in a subcutaneous pocket formed in the left anterior chest wall and connected to the lead system. DFT was determined by a three-reversal, step up-down method to estimate the 80% success level. Two configurations were tested for the conventional ICD (#1: RV to SVC+AC; #2: RV to AC). A single configuration (RV to SVC+IVC) was evaluated for the PICD. RESULTS Mean PICD DFT was 14.8 ± 1.53 (SE) J. Conventional #1 configuration demonstrated mean DFT of 20.2 ± 2.45 J and #2 of 27.5 ± 1.95 J. The PICD had a significantly lower DFT than the better conventional ICD configuration (#1; mean difference 5.4 ± 2.1 J, P <.05, paired t-test, N = 8). CONCLUSION The new intravascular defibrillator had a significantly lower DFT than the conventional ICD in this canine model.
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Kroll MW, Schwab JO. Achieving low defibrillation thresholds at implant: pharmacological influences, RV coil polarity and position, SVC coil usage and positioning, pulse width settings, and the azygous vein. Fundam Clin Pharmacol 2010; 24:561-73. [DOI: 10.1111/j.1472-8206.2010.00848.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Val-Mejias JE, Oza A. Does defibrillation threshold increase as left ventricular ejection fraction decreases? Europace 2010; 12:385-8. [PMID: 20047925 PMCID: PMC2825386 DOI: 10.1093/europace/eup408] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims Advanced cardiac disease, entailing more hypertrophy, fibrosis, scarring, dilatation and conduction delays, poses the question of whether defibrillation thresholds (DFTs) increase as left ventricular ejection fraction (LVEF) decreases. This question has been approached indirectly or insufficiently in previous studies. In this study we add and expand on our previous work, stratifying DFT for various LVEF ranges. Methods and results This retrospective analysis included DFT data from three acute, multicentre, randomized studies that included 230 ICD/CRT-D patients. All DFTs were obtained with the SVC coil turned ON and with pulse-width optimized waveforms based on a 3.5 ms membrane time constant. As the LVEF decreased, DFT estimates increased from 395.2 ± 115 V for LVEF ≥ 46% to 425.8 ± 117.6 V for LVEF ≤ 25%. However, these changes in DFT estimates were very minor and not statistically significant. Only 3% of the patients in this population had an elevated DFT of >20 J. Conclusion This analysis shows that over a very broad range of LVEF, DFT changes minimally (approximately 1 J), if at all. Our results are consistent with previous studies that demonstrated no difference in the DFT estimates: (a) between patient groups receiving ICD (typically higher LVEF) vs. CRT-D (typically lower LVEF) and (b) between patient groups receiving a device for primary prevention indications (typically lower LVEF) vs. secondary prevention indications (typically higher LVEF).
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Affiliation(s)
- Jesus E Val-Mejias
- Galichia Heart Hospital, 2600 N. Woodlawn Avenue, Wichita, KS 67226, USA.
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Kalahasty G, Ellenbogen KA. ICD Lead Design and the Management of Patients with Lead Failure. Card Electrophysiol Clin 2009; 1:173-191. [PMID: 28770783 DOI: 10.1016/j.ccep.2009.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The implantable cardioverter defibrillator (ICD) lead is critical to the function of the ICD system. The mortality reduction associated with ICDs implanted for primary prevention indications has been made possible by the development of effective and reliable transvenous ICD leads. Mortality rates for implantation of transvenous ICD lead systems are currently less than 0.5%. The reliability and functional characteristics of a lead are often not known until it has been in widespread use. An understanding of the mechanism of lead failure is essential for proper patient management. This article describes the design and construction of ICD leads, discusses lead failure, and reviews subsequent management of patients.
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Affiliation(s)
- Gautham Kalahasty
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, PO Box 980053, VA 23298-0053, USA
| | - Kenneth A Ellenbogen
- Division of Cardiology, Cardiac Electrophysiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298-0053, USA
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GOLD MICHAELR, KROLL MARKW, ELLENBOGEN KENNETHA. Defibrillation Testing at ICD Implantation: Are We Asking the Wrong Question? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:567-9. [DOI: 10.1111/j.1540-8159.2009.02327.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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VARMA NIRAJ, EFIMOV IGOR. Right Pectoral Implantable Cardioverter Defibrillators: Role of the Proximal (SVC) Coil. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1025-35. [DOI: 10.1111/j.1540-8159.2008.01130.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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