Novel use of a vascular plug to anchor an azygous vein ICD lead.
We describe the case of a young patient with severe hypertrophic cardiomyopathy and marginal defibrillation thresholds (DFTs) at implant of a standard transvenous implantable cardioverter-defibrillator (ICD) system. The patient subsequently experienced multiple failed ICD shocks during a prolonged episode of spontaneous ventricular tachycardia/fibrillation. Placement of a second single-coil shocking lead in the azygous vein resulted in acceptable DFTs, but the new lead migrated superiorly within hours of the procedure. To stabilize the lead position, a vascular plug was placed in the distal azygous vein, and the shocking lead screw was actively fixated to the meshwork of the device. Subsequent testing confirmed both adequate defibrillation and stable lead position.
Bar-Cohen
Yaniv
Y
Division of Cardiology, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA 90027, USA. ybarcohen@chla.usc.edu
Takao
Cheryl M
CM
Wells
Winfield J
WJ
Saxon
Leslie A
LA
Cesario
David A
DA
Silka
Michael J
MJ
D000293:Adolescent; D001807:Blood Vessel Prosthesis; D009202:Cardiomyopathies / Q000517:prevention & control*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome