Limits...
Azygos vein lead implantation for high defibrillation thresholds in implantable cardioverter defibrillator placement.

Kommuri NV, Kollepara SL, Saulitis E, Siddiqui M - Indian Pacing Electrophysiol J (2010)

Bottom Line: Evaluation of defibrillation threshold is a standard of care during implantation of implantable cardioverter defibrillator.High defibrillation thresholds are often encountered and pose a challenge to electrophysiologists to improve the defibrillation threshold.We describe a case series where defibrillation thresholds were improved after implanting a defibrillation lead in the azygos vein.

View Article: PubMed Central - PubMed

Affiliation: Sinai-Grace Hospital, 6071 West Outer Drive, Detroit Medical Center, MI 48235, USA.

ABSTRACT
Evaluation of defibrillation threshold is a standard of care during implantation of implantable cardioverter defibrillator. High defibrillation thresholds are often encountered and pose a challenge to electrophysiologists to improve the defibrillation threshold. We describe a case series where defibrillation thresholds were improved after implanting a defibrillation lead in the azygos vein.

No MeSH data available.


Chest X-ray showing the position of azygous vein lead
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2803605&req=5

Figure 2: Chest X-ray showing the position of azygous vein lead

Mentions: After informed consent was obtained, patient was prepared and draped in standard sterile fashion. Venous access was obtained through left axillary vein by modified seldinger technique, introducers were placed, leads were advanced and positioned in the right ventricular apex (0181 ICD lead Guidant), right atrial appendage (4086 Guidant) and via the coronary sinus in the posterior lateral aspect of the left ventricle (4517 Guidant). After demonstration of appropriate pacing sensing function, the leads were anchored to pectoralis muscle and connected to a Guidant pulse generator (H 219). The leads along with pulse generator were placed inside the prepectoral pocket and the defibrillation threshold was assessed. There was difficulty in defibrillating at initial polarity and reversed polarity at 21 and 31 joules. A separate Superior vena cava (SVC) coil was placed at the juncture of the SVC and right atrium which did not improve the defibrillation threshold in either polarity. Subsequently the azygos vein was cannulated utilizing a Rapido IC 90, then a long sheath was placed and a Transvene lead (6937 A-Medtronic) was placed in azygos vein and the patient was successfully defibrillated at 31 joules (Figure 1A). Post operative chest x-ray confirmed the position of lead (Figure 2A)


Azygos vein lead implantation for high defibrillation thresholds in implantable cardioverter defibrillator placement.

Kommuri NV, Kollepara SL, Saulitis E, Siddiqui M - Indian Pacing Electrophysiol J (2010)

Chest X-ray showing the position of azygous vein lead
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803605&req=5

Figure 2: Chest X-ray showing the position of azygous vein lead
Mentions: After informed consent was obtained, patient was prepared and draped in standard sterile fashion. Venous access was obtained through left axillary vein by modified seldinger technique, introducers were placed, leads were advanced and positioned in the right ventricular apex (0181 ICD lead Guidant), right atrial appendage (4086 Guidant) and via the coronary sinus in the posterior lateral aspect of the left ventricle (4517 Guidant). After demonstration of appropriate pacing sensing function, the leads were anchored to pectoralis muscle and connected to a Guidant pulse generator (H 219). The leads along with pulse generator were placed inside the prepectoral pocket and the defibrillation threshold was assessed. There was difficulty in defibrillating at initial polarity and reversed polarity at 21 and 31 joules. A separate Superior vena cava (SVC) coil was placed at the juncture of the SVC and right atrium which did not improve the defibrillation threshold in either polarity. Subsequently the azygos vein was cannulated utilizing a Rapido IC 90, then a long sheath was placed and a Transvene lead (6937 A-Medtronic) was placed in azygos vein and the patient was successfully defibrillated at 31 joules (Figure 1A). Post operative chest x-ray confirmed the position of lead (Figure 2A)

Bottom Line: Evaluation of defibrillation threshold is a standard of care during implantation of implantable cardioverter defibrillator.High defibrillation thresholds are often encountered and pose a challenge to electrophysiologists to improve the defibrillation threshold.We describe a case series where defibrillation thresholds were improved after implanting a defibrillation lead in the azygos vein.

View Article: PubMed Central - PubMed

Affiliation: Sinai-Grace Hospital, 6071 West Outer Drive, Detroit Medical Center, MI 48235, USA.

ABSTRACT
Evaluation of defibrillation threshold is a standard of care during implantation of implantable cardioverter defibrillator. High defibrillation thresholds are often encountered and pose a challenge to electrophysiologists to improve the defibrillation threshold. We describe a case series where defibrillation thresholds were improved after implanting a defibrillation lead in the azygos vein.

No MeSH data available.