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Qian S, Monaci S, Mendonca-Costa C, Campos F, Gemmell P, Zaidi HA, Rajani R, Whitaker J, Rinaldi CA, Bishop MJ. Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement: a simulation study. Europace 2023; 25:euad146. [PMID: 37314196 PMCID: PMC10265967 DOI: 10.1093/europace/euad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS The standard implantable cardioverter defibrillator (ICD) generator (can) is placed in the left pectoral area; however, in certain circumstances, right-sided cans may be required which may increase defibrillation threshold (DFT) due to suboptimal shock vectors. We aim to quantitatively assess whether the potential increase in DFT of right-sided can configurations may be mitigated by alternate positioning of the right ventricular (RV) shocking coil or adding coils in the superior vena cava (SVC) and coronary sinus (CS). METHODS AND RESULTS A cohort of CT-derived torso models was used to assess DFT of ICD configurations with right-sided cans and alternate positioning of RV shock coils. Efficacy changes with additional coils in the SVC and CS were evaluated. A right-sided can with an apical RV shock coil significantly increased DFT compared to a left-sided can [19.5 (16.4, 27.1) J vs. 13.3 (11.7, 19.9) J, P < 0.001]. Septal positioning of the RV coil led to a further DFT increase when using a right-sided can [26.7 (18.1, 36.1) J vs. 19.5 (16.4, 27.1) J, P < 0.001], but not a left-sided can [12.1 (8.1, 17.6) J vs. 13.3 (11.7, 19.9) J, P = 0.099). Defibrillation threshold of a right-sided can with apical or septal coil was reduced the most by adding both SVC and CS coils [19.5 (16.4, 27.1) J vs. 6.6 (3.9, 9.9) J, P < 0.001, and 26.7 (18.1, 36.1) J vs. 12.1 (5.7, 13.5) J, P < 0.001]. CONCLUSION Right-sided, compared to left-sided, can positioning results in a 50% increase in DFT. For right-sided cans, apical shock coil positioning produces a lower DFT than septal positions. Elevated right-sided can DFTs may be mitigated by utilizing additional coils in SVC and CS.
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Affiliation(s)
- Shuang Qian
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Sofia Monaci
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Caroline Mendonca-Costa
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Fernando Campos
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Philip Gemmell
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Hassan A Zaidi
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
| | - Ronak Rajani
- Department of Cardiology, Guy’s and St Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - John Whitaker
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - Christopher A Rinaldi
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
- Department of Cardiology, Guy’s and St Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - Martin J Bishop
- Department of Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, 4th North Wing, St Thomas’ Hospital, London SE1 7EH, UK
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 686] [Impact Index Per Article: 343.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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3
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Le KV, Okamura H, Nakajima K, Noda T, Kusano K. Undersensing of ventricular fibrillation by a biventricular implantable cardioverter-defibrillator: What is the cause and the troubleshooting? J Arrhythm 2019; 35:276-278. [PMID: 31007793 PMCID: PMC6457377 DOI: 10.1002/joa3.12170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/17/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kien Vo Le
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Hideo Okamura
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
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Al-Atia B, Vandenberk B, Vörös G, Garweg C, Ector J, Willems R. Predictors of a high defibrillation threshold test during routine ICD implantation. Acta Cardiol 2018; 73:267-273. [PMID: 28885097 DOI: 10.1080/00015385.2017.1371455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is growing evidence that routine defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation is not necessary. However a small group of patients might be at risk if no DFT testing is performed. METHODS Patients with a new pectoral ICD implantation in our hospital between 2006 and 2014 were included in a retrospective registry. A clinical high DFT was defined as a safety margin <10 J of the maximal device output. Logistic regression for prediction of high DFT was performed using patient characteristics, clinical, echocardiographic and device-related parameters. RESULTS DFT testing was performed in 788/864 (91.2%) procedures. In 76 (8.8%) patients no DFT testing was performed mainly due to atrial fibrillation, intra-cardiac thrombus, hemodynamic instability or logistical reasons. A high DFT was present in 44 (5.6%) patients. A QRS duration ≥150 ms, a low left ventricular ejection fraction (LVEF ≤25%), a severely dilated left ventricle ≥60 mm and right sided pre-pectoral implantations were univariate predictors of a high DFT. Independent predictors of a high DFT were a LVEF ≤25% (HR 2.195, 95%CI 1.085-4.443) and right sided pre-pectoral implantations (HR 3.135, 95% CI 1.186-8.287). CONCLUSIONS A high DFT is still present in about 5% of patients and is more frequent in patients with a severely dilated left ventricle, a very low LVEF, right sided pre-pectoral implantation and wider QRS duration. It might be clinically important to continue DFT testing in these high risk patients.
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Affiliation(s)
- B. Al-Atia
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - B. Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - G. Vörös
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - C. Garweg
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - J. Ector
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - R. Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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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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Varma N, Schaerf R, Kalbfleisch S, Pimentel R, Kroll MW, Oza A. Defibrillation thresholds with right pectoral implantable cardioverter defibrillators and impact of waveform tuning (the Tilt and Tune trial). Europace 2016; 19:1810-1817. [DOI: 10.1093/europace/euw306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/30/2016] [Indexed: 11/14/2022] Open
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Defibrillation Threshold Testing: Who Doesn't Get It? Card Electrophysiol Clin 2016; 4:135-41. [PMID: 26939810 DOI: 10.1016/j.ccep.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Defibrillation testing has been routinely performed as part of the implantable cardioverter-defibrillator (ICD) implantation procedure, and is currently supported by practice guidelines; however, more recently, this practice has been called into question. Such testing is safe, and serious complications are rare. With modern ICD systems, physicians will rarely encounter a patient in whom defibrillation will fail. This article reviews the literature regarding the utility, necessity, complications, and cost of routine operative and follow-up defibrillation testing, and, it is hoped, clarifies the issue of "Who doesn't get it?"
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8
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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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9
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Tsurugi T, Matsui S, Nakajima H, Nishii N, Honda T, Kaneko Y. Various mechanisms and clinical phenotypes in electrical short circuits of high-voltage devices: report of four cases and review of the literature. Europace 2015; 17:909-14. [DOI: 10.1093/europace/euv022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/27/2015] [Indexed: 11/13/2022] Open
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10
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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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11
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Recommendations for the Programming of Implantable Cardioverter-Defibrillators in New Zealand. Heart Lung Circ 2012; 21:765-77. [DOI: 10.1016/j.hlc.2012.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 07/17/2012] [Accepted: 07/21/2012] [Indexed: 11/23/2022]
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12
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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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13
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Affiliation(s)
- Sony Jacob
- From the Division of Cardiology/Electrophysiology, Harper University hospital, Wayne State University, Detroit, Mich
| | - Randy A. Lieberman
- From the Division of Cardiology/Electrophysiology, Harper University hospital, Wayne State University, Detroit, Mich
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14
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A successful implantation of a dual-chambers cardioverter defibrillator for a patient with severe tortuous persistent left superior vena cava. Int J Cardiol 2009; 133:e109-10. [PMID: 18342961 DOI: 10.1016/j.ijcard.2007.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 12/11/2007] [Indexed: 11/21/2022]
Abstract
We report a case of successful implantation of a dual-chambers transvenous cardioverter defibrillator for a dilated cardiomyopathy patient with severe tortuous persistent left superior vena cava and a very small innominate vein. After confirming the presence of a right superior vena cava, a dilated sheath was advanced into the narrow innominate vein to increase the lumen of innominate vein. The active atrial and ventricular leads were successfully inserted into right atrium and right ventricle through innominate bridge by the support of steerable long sheaths.
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15
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Maass AH, Waterbolk TW, Van Gelder IC. Pitfalls of internal cardioverter defibrillator implantation: Part II. Europace 2008; 11:268-70. [DOI: 10.1093/europace/eun345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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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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17
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Mollerus M, Lipinski M, Munger T. A randomized comparison of defibrillation thresholds in the right ventricular outflow tract versus right ventricular apex. J Interv Card Electrophysiol 2008; 22:221-5. [DOI: 10.1007/s10840-008-9254-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 03/07/2008] [Indexed: 11/29/2022]
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18
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Snow JS, Larsen A, Cohen TJ. Transvenous Biventricular Defibrillation Can Improve Defibrillation Threshold. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1327-8. [PMID: 15461729 DOI: 10.1111/j.1540-8159.2004.00630.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A case report of a patient with a high defibrillation threshold at initial implantation that was improved by the insertion of a shocking coil in the left lateral cardiac vein is discussed.
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Affiliation(s)
- Jeffrey S Snow
- Division of Cardiology, Winthrop University Hospital, Mineola, New York, USA.
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19
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Kirk MM, Shorofsky SR, Gold MR. Comparison of the effects of active left and right pectoral pulse generators on defibrillation efficacy. Am J Cardiol 2001; 88:1308-11. [PMID: 11728363 DOI: 10.1016/s0002-9149(01)02096-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M M Kirk
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Abstract
Implantable cardioverter defibrillators (ICDs) have evolved from the treatment of last resort to the gold standard therapy for patients at high risk for ventricular tachyarrhythmias. High-risk patients include those who have survived life-threatening arrhythmias, and individuals with cardiac diseases who are at risk for such arrhythmias, but are symptomless. Use of an ICD will affect the patient's quality of life. Some drugs can substantially affect defibrillator function and efficacy, and possible drug-device interactions should be considered. Patients with ICDs may encounter cell phones, antitheft detectors, and many other sources of potential electromagnetic Interference. In addition to treating ventricular tachyarrhythmias, new defibrillators provide full featured dual chamber pacing, and could treat atrial arrhythmias, and congestive heart failure by means of biventricular pacing.
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Affiliation(s)
- M Glikson
- Heart Institute, Sheba Medical Centre, Tel Aviv University, Tel Hashomer, Israel
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21
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Friedman PA, Glikson M, Stanton MS. Defibrillator challenges for the new millennium: the marriage of device and patient-making and maintaining a good match. J Cardiovasc Electrophysiol 2000; 11:697-709. [PMID: 10868745 DOI: 10.1111/j.1540-8167.2000.tb00034.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although it has become clear that implantable cardioverter defibrillators (ICDs) are effective, important challenges remain for the physician. Due to the limitations of available risk stratification tools, patient selection for primary sudden death prevention remains controversial in many populations. Additionally, the proliferation of device choices has led to challenges in matching the appropriate device to the individual patient: device size is balanced against longevity; the advantages of dual chamber systems is weighed against their increased complexity; physician and patient preferences in device implant site are constrained by site-dependent effects on defibrillation effectiveness and lead failure rates; and special consideration must be given to the patient with a preexisting pacemaker. After ICD placement, determination of appropriate follow-up frequency and methodology to assess device function must be considered. This article will review patient selection, device implant site selection, device-device interactions, single versus dual chamber ICD selection, and follow-up.
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Affiliation(s)
- P A Friedman
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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