Hemiazygous coil placement for high-defibrillation thresholds in a patient with a right-sided implantable cardioverter defibrillator.
A 41-year-old man underwent implantation of a right-sided implantable cardioverter defibrillator after removal of an infected left-sided system. Defibrillation threshold (DFT) testing on the right-sided system failed to convert ventricular fibrillation at maximum device output (35 J) compared with a DFT of less than 15 J on the previous left-sided system. A single-coil lead was selectively placed into the hemiazygous vein, which courses leftward of the spine in a posterior-anterior projection, resulting in an improved shocking vector and reduction in DFTs to less than 25 J.
Nilsson
Kent R
KR
Division of Clinical Cardiac Electrophysiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Jackson
Kevin P
KP
D000328:Adult; D001401:Azygos Vein / Q000601:surgery*; D017147:Defibrillators, Implantable; D004056:Differential Threshold; D004567:Electrodes, Implanted; D006333:Heart Failure / Q000517:prevention & control*; D006801:Humans; D008297:Male; D016896:Treatment Outcome