High defibrillation threshold with right-sided ICD implantation was resolved by a dual coil lead via persistent left superior vena cava. Issue 5 (May 2022)

• Record Type: Journal Article
• Authors: Fujito, Takefumi; Nagahara, Daigo; Tsuzuki, Taro; Kamiyama, Naoyuki; Mochizuki, Atsushi; Miura, Tetsuji
• Is Part Of: Journal of cardiology cases. Volume 25:Issue 5(2022)
• Page Start: 262
• Page End: 265
• Publication Date: 2022-05
• Subjects: CS coronary sinus -- DFT defibrillation threshold -- EF ejection fraction -- ICD implantable cardioverter defibrillator -- LV left ventricular -- PLSVC persistent left superior vena cava -- SVC superior vena cava -- VF ventricular fibrillation; Coronary sinus -- Defibrillation test -- High defibrillation threshold -- Implantable cardioverter defibrillator -- Persistent left superior vena cava; Cardiology -- Periodicals; Cardiovascular Diseases -- Case Reports; Cardiovascular Diseases -- Periodicals; Cardiology -- Case Reports; Cardiology -- Periodicals; Cardiology; Electronic journals; Periodicals; 616.12
• DOI: 10.1016/j.jccase.2021.10.012
• Languages: English
• ISSNs: 1878-5409

Abstract

Abstract: Persistent left superior vena cava (PLSVC) can be problematic when device implantation is scheduled from the left side because of the technical difficulty in delivering leads. Right-sided implantation is an alternative method, but there is a risk of a high defibrillation threshold (DFT). Transvenous implantation of an implantable cardioverter defibrillator (ICD) was scheduled for a 54-year-old man with idiopathic dilated cardiomyopathy and monomorphic non-sustained ventricular tachycardia, but computed tomography revealed the presence of a PLSVC. Right-sided ICD implantation was performed first; however, an ICD shock at 35 J failed to terminate the induced ventricular fibrillation (VF). Re-implantation via the PLSVC by a left subclavian approach with a dual coil lead was performed next. The dual coil right ventricular lead was successfully implanted via the PLSVC, and the induced VF was terminated by a single shock at 25 J. In the present case, the proximal coil was located in the coronary sinus (CS) and it enabled an antero-posterior defibrillation vector across the left ventricle. In addition to the re-location of the ICD generator from the right side to the left side, the new positioning of the proximal coil inside the CS is likely to have contributed to the great improvement of the DFT. <Learning objective: In cases with persistent left superior vena cava, left-sided implantationof an implantable cardioverter defibrillator (ICD) can be problematic because of the technical difficulty, but right-sided implantation has a risk of a high defibrillation threshold (DFT). Leftsided ICD via the persistent left superior vena cava with a dual coil lead enables an antero-posterior defibrillation vector across the left ventricle by positioning of the proximal coil inside the coronary sinus and contributes to a great improvement of the DFT.>