title: Concept of defibrillation vector in the management of high defibrillation threshold.
abstract: We present a case where defibrillation threshold was dangerously elevated to the point that the patient had no safety margin, and his implantable cardioverter-defibrillator generator was discovered to have migrated. Generator migration reduces the distance between the can and the coil, effectively creating a smaller bipolar current and sparing the left ventricle from the current needed for defibrillation. This case underscores the importance of securing the generator in place, as this patient would have been spared multiple shocks and an invasive medical procedure had his generator been better secured.
authors.affiliation: Kevin Hayes, Abhishek Deshmukh, Hakan Paydak, Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hayes
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.forename: Sadip
authors.initials: S
authors.lastname: Pant
authors.forename: Gareth
authors.initials: G
authors.lastname: Tobler
authors.forename: Hakan
authors.initials: H
authors.lastname: Paydak
keywords: Defibrillation threshold; Implantable cardioverter-defibrillator; Pacemaker; Ventricular tachycardia