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Fujito T, Nagahara D, Tsuzuki T, Kamiyama N, Mochizuki A, Miura T. High defibrillation threshold with right-sided ICD implantation was resolved by a dual coil lead via persistent left superior vena cava. J Cardiol Cases 2022; 25:262-265. [PMID: 35582083 PMCID: PMC9091524 DOI: 10.1016/j.jccase.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/30/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) can be problematic when device implantation is scheduled from the left side because of the technical difficulty in delivering leads. Right-sided implantation is an alternative method, but there is a risk of a high defibrillation threshold (DFT). Transvenous implantation of an implantable cardioverter defibrillator (ICD) was scheduled for a 54-year-old man with idiopathic dilated cardiomyopathy and monomorphic non-sustained ventricular tachycardia, but computed tomography revealed the presence of a PLSVC. Right-sided ICD implantation was performed first; however, an ICD shock at 35 J failed to terminate the induced ventricular fibrillation (VF). Re-implantation via the PLSVC by a left subclavian approach with a dual coil lead was performed next. The dual coil right ventricular lead was successfully implanted via the PLSVC, and the induced VF was terminated by a single shock at 25 J. In the present case, the proximal coil was located in the coronary sinus (CS) and it enabled an antero-posterior defibrillation vector across the left ventricle. In addition to the re-location of the ICD generator from the right side to the left side, the new positioning of the proximal coil inside the CS is likely to have contributed to the great improvement of the DFT. .
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Affiliation(s)
- Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daigo Nagahara
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Taro Tsuzuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Kamiyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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Kawada S, Chakraborty P, Albertini L, Bhaskaran A, Oechslin EN, Sliversides C, Wald RM, Roche SL, Harris L, Swan L, Alonso-Gonzalez R, Thorne S, Downar E, Nanthakumar K, Mondésert B, Khairy P, Nair K. Safety and Long-term Outcomes of Defibrillator Therapy in Patients With Right-Sided Implantable Cardiac Devices in Adults With Congenital Heart Disease. Can J Cardiol 2020; 37:407-416. [PMID: 32522524 DOI: 10.1016/j.cjca.2020.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/22/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) have been proven to prevent sudden cardiac death in adult congenital heart disease (ACHD) patients. Although the left side is chosen by default, implantation from the right side is often required. However, little is known about the efficacy and safety of right-sided ICDs in ACHD patients. METHODS In this study we reviewed a total of 191 ACHD patients undergoing ICD/cardioverter resynchronisation therapy-defibrillator (CRT-D) implantation at our hospital between 2001 and 2019 (134 men and 57 women; age [mean ± standard deviation], 41.5 ± 14.8 years). RESULTS Twenty-seven patients (14.1%) had right-sided devices. The most common causes of right-sided implantation were persistent left superior vena cava and vein occlusion (37.0%). Although procedure time (202.8 ± 60.5 minutes vs 143.8 ± 69.1 minutes, P = 0.008) was longer and the procedural success was lower (92.6% vs 99.4%, P = 0.008) for right-sided devices, no difference in R-wave and pacing threshold were noted. Among the 47 patients (24.6%) who underwent defibrillation threshold testing (DFT), no difference in DFT was observed (25.2 ± 5.3 J vs 23.8 ± 4.1 J, P = 0.460). During the median follow-up of 42.4 months, appropriate ICD therapy was observed in 5 (18.5%) and 30 (18.3%) patients for right- and left-sided ICDs/CRTDs, respectively (P = 0.978). No significant difference was seen in complications between them. CONCLUSIONS Implantation of an ICD on the right side is technically challenging, but it is feasible as an alternative approach for ACHD patients with contraindications to left-sided device implantation.
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Affiliation(s)
- Satoshi Kawada
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Praloy Chakraborty
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Lisa Albertini
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Abhishek Bhaskaran
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Erwin N Oechslin
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Candice Sliversides
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Rachel M Wald
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - S Lucy Roche
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Louise Harris
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Lorna Swan
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Rafael Alonso-Gonzalez
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Sara Thorne
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Eugene Downar
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Kumaraswamy Nanthakumar
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada
| | - Blandine Mondésert
- Department of Cardiology, Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Paul Khairy
- Department of Cardiology, Montreal Heart Institute, University of Montreal, Montreal, Québec, Canada
| | - Krishnakumar Nair
- University Health Network Toronto, Peter Munk Cardiac Centre and University of Toronto, Toronto, Ontario, Canada.
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Cay S, Ozeke O, Ozcan F, Topaloglu S, Aras D. Overcoming difficulties related with persistent left superior vena cava. J Cardiovasc Electrophysiol 2020; 31:2264-2265. [PMID: 32449552 DOI: 10.1111/jce.14578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Serkan Cay
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozcan Ozeke
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Firat Ozcan
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Serkan Topaloglu
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Dursun Aras
- Division of Arrhythmia and Electrophysiology, Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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