title: Cardiac amyloidosis treated with an implantable cardioverter defibrillator and subcutaneous array lead system: report of a case and literature review.
abstract: BACKGROUND
  Preventing ventricular arrhythmias in patients with cardiac amyloidosis is challenging since the amyloid protein deposition in the myocardium may interfere with the normal cardiac electric excitation. Most of these patients succumb to either progressive congestive heart failure, or sudden cardiac death (SCD). Implantable cardioverter defibrillator (ICD) offers a near sure means of preventing SCD.
  
  
  OBJECTIVE
  Myocardial infiltration with amyloid results in elevated defibrillation threshold (DFT). Intra-operative strategies may fail to lower DFT during implantation.
  
  
  METHODS
  We present a case of a 64-year-old female who had cardiac amyloidosis, and was successfully treated with an ICD and a subcutaneous array lead system.
  
  
  CONCLUSIONS
  A subcutaneous array lead system is useful in reducing the DFT, and can terminate ventricular tachycardia or fibrillation by allowing more energy delivery and efficient defibrillation.
authors.affiliation: Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan 48823, USA.
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Dhoble
authors.forename: Atul
authors.initials: A
authors.lastname: Khasnis
authors.forename: Adesuwa
authors.initials: A
authors.lastname: Olomu
authors.forename: Ranjan
authors.initials: R
authors.lastname: Thakur
mesh_terms: D000686:Amyloidosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000628:therapy*