TY - JOUR
T1 - The azygos defibrillator lead for elevated defibrillation thresholds
T2 - Implant technique, lead stability, and patient series
AU - Cooper, Jonas A.
AU - Latacha, Matthew P.
AU - Soto, Gabriel E.
AU - Garmany, Richard G.
AU - Gleva, Marye J.
AU - Chen, Jane
AU - Faddis, Mitchell N.
AU - Smith, Timothy W.
PY - 2008/11
Y1 - 2008/11
N2 - Background: Conventional insertion of implantable cardioverter- defibrillator (ICD) includes an evaluation of the defibrillation threshold (DFT). Implanting an ancillary defibrillation lead in the azygos vein has been introduced as a therapeutic option in patients with "high" DFT. This study reports the efficacy and stability of azygos defibrillation coils implanted for elevated DFTs. Methods: This is a retrospective review of seven consecutive patients with right and left pectoral, single- and dual-chamber, and biventricular ICDs and elevated DFTs, in whom an azygos defibrillation coil was introduced. Results: Addition of an azygos defibrillator lead achieved a satisfactory safety margin during single energy defibrillation efficacy testing in four out of seven patients, with success at maximum device output in two patients. No satisfactory safety margin was achieved in the remaining patient, despite the further addition of a subcutaneous defibrillation coil. No change in lead position was observed over a mean radiographic follow-up of 8 months. No complications were noted during a mean follow-up of 14 months, including no deaths, and no ICD shocks. Conclusion: Implanting a defibrillation coil into the azygos vein is feasible and safe. In a majority of patients with failed defibrillation efficacy testing, adding an azygos coil achieves success on repeat testing. Therefore, this technique is one option for lowering the defibrillation threshold in patients who fail DFT testing of their ICD.
AB - Background: Conventional insertion of implantable cardioverter- defibrillator (ICD) includes an evaluation of the defibrillation threshold (DFT). Implanting an ancillary defibrillation lead in the azygos vein has been introduced as a therapeutic option in patients with "high" DFT. This study reports the efficacy and stability of azygos defibrillation coils implanted for elevated DFTs. Methods: This is a retrospective review of seven consecutive patients with right and left pectoral, single- and dual-chamber, and biventricular ICDs and elevated DFTs, in whom an azygos defibrillation coil was introduced. Results: Addition of an azygos defibrillator lead achieved a satisfactory safety margin during single energy defibrillation efficacy testing in four out of seven patients, with success at maximum device output in two patients. No satisfactory safety margin was achieved in the remaining patient, despite the further addition of a subcutaneous defibrillation coil. No change in lead position was observed over a mean radiographic follow-up of 8 months. No complications were noted during a mean follow-up of 14 months, including no deaths, and no ICD shocks. Conclusion: Implanting a defibrillation coil into the azygos vein is feasible and safe. In a majority of patients with failed defibrillation efficacy testing, adding an azygos coil achieves success on repeat testing. Therefore, this technique is one option for lowering the defibrillation threshold in patients who fail DFT testing of their ICD.
KW - Azygos lead
KW - Defibrillation
KW - Defibrillation threshold test
KW - Implantable cardioverter-defibrillator
KW - Subcutaneous lead
UR - http://www.scopus.com/inward/record.url?scp=53749099750&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8159.2008.01203.x
DO - 10.1111/j.1540-8159.2008.01203.x
M3 - Article
C2 - 18950297
AN - SCOPUS:53749099750
SN - 0147-8389
VL - 31
SP - 1405
EP - 1410
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
IS - 11
ER -