title: A biventricular ICD system with biventricular defibrillation.
abstract: We describe the case of a 59-year-old gentleman with severe dilated cardiomyopathy requiring implantation of a dual-chamber biventricular implantable cardioverter-defibrillator (ICD). High defibrillation thresholds (DFT) were encountered at implant with an inadequate defibrillation safety margin. Testing of all possible shock vectors/polarities with and without the SVC coil and optimization of the distal RV coil position all proved inadequate. A satisfactory defibrillation safety margin was achieved following placement of a second lead in the coronary sinus to enable biventricular defibrillation. This case highlights an additional strategy for combating high DFTs and is an option even in dual-chamber biventricular ICD systems.
authors.affiliation: Derriford Hospital, Plymouth, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Spurrell
authors.forename: Manish
authors.initials: M
authors.lastname: Gandhi
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D004554:Electric Countershock / Q000379:methods*; D004567:Electrodes, Implanted; D004868:Equipment Failure; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000628:therapy*