open access

Vol 70, No 11 (2012)
Invasive electrophysiology
Published online: 2012-11-21
Submitted: 2012-12-28
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Change of defibrillation vector with addition of an azygos vein coil lowers defibrillation threshold

Marek Jastrzębski, Danuta Czarnecka
Kardiol Pol 2012;70(11):1202-1204.

open access

Vol 70, No 11 (2012)
Invasive electrophysiology
Published online: 2012-11-21
Submitted: 2012-12-28

Abstract

A 34-year-old male with dilated cardiomyopathy and advanced heart failure was referred for defibrillator implantation for primary prevention of sudden cardiac death. During implantation despite multiple right ventricular (RV) lead positions (outflow tract, septum, apex) and various defibrillation vector combinations (superior vena cava coil on/off, polarity reversal, tilt change), the maximum energy shock (40 J) from the implanted device was unsuccessful in restoring the sinus rhythm. In a straightforward fashion another regular single coil shocking lead was introduced to the azygos vein using telescoping system for coronary sinus cannulation and coronary vein subselection. The terminal pin of the new shocking coil was inserted into the superior vena cava coil port of the device header; the old superior vena cava coil pin and the redundant RV pacing IS-1 pin of the new lead were caped. This resulted in a successful defibrillation with the energy of 30 J and thus in obtaining the required 10 J safety margin. Azygos vein implantation technique was described and it’s merits discussed.

Abstract

A 34-year-old male with dilated cardiomyopathy and advanced heart failure was referred for defibrillator implantation for primary prevention of sudden cardiac death. During implantation despite multiple right ventricular (RV) lead positions (outflow tract, septum, apex) and various defibrillation vector combinations (superior vena cava coil on/off, polarity reversal, tilt change), the maximum energy shock (40 J) from the implanted device was unsuccessful in restoring the sinus rhythm. In a straightforward fashion another regular single coil shocking lead was introduced to the azygos vein using telescoping system for coronary sinus cannulation and coronary vein subselection. The terminal pin of the new shocking coil was inserted into the superior vena cava coil port of the device header; the old superior vena cava coil pin and the redundant RV pacing IS-1 pin of the new lead were caped. This resulted in a successful defibrillation with the energy of 30 J and thus in obtaining the required 10 J safety margin. Azygos vein implantation technique was described and it’s merits discussed.
Get Citation

Keywords

high defibrillation threshold; azygos vein; defibrillation vector; implantable cardioverter-defibrillator; sudden death

About this article
Title

Change of defibrillation vector with addition of an azygos vein coil lowers defibrillation threshold

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 70, No 11 (2012)

Pages

1202-1204

Published online

2012-11-21

Bibliographic record

Kardiol Pol 2012;70(11):1202-1204.

Keywords

high defibrillation threshold
azygos vein
defibrillation vector
implantable cardioverter-defibrillator
sudden death

Authors

Marek Jastrzębski
Danuta Czarnecka

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