Overcoming High Defibrillation Thresholds With Placement of a Coronary Sinus Lead
Document Type
Abstract
Publication Title
Journal of the American College of Cardiology
Abstract
Background: Conventional implantable cardioverter-defibrillators (ICD) lead placement consists of a right ventricular lead with or without superior vena cava lead. Inadequate safety margins for DFTs are encountered in up to 8% of ICD placements, which can result in inability to successfully terminate fatal ventricular arrhythmias. In patients with inadequate DFTs, we proposed placing a lead in the coronary sinus or one of its branches would achieve adequate thresholds.
Methods: Patients who had inadequate DFTs with conventional leads defined by >20 J threshold underwent immediate addition of coronary sinus lead. DFT testing was performed pre- and post-coronary sinus lead implantation. A total of 16 patients underwent coronary sinus lead placement from October 16, 2007 to March 26, 2020. Statistical analysis for pre- and post-coronary sinus lead energy thresholds was performed with a paired T-test.
Results: Fourteen patients at the time of initial ICD implantation and two patients at time of revision with inadequate DFTs with conventional leads underwent coronary sinus lead placement. The mean age was 50 years and the mean left ventricular ejection was 18%. Comparison of DFTs (as shown in Figure 1) showed a reduced energy requirement with a p-value of 0.0025 (95% CI 4.69 - 18.06), a statistically significant improvement in DFT.
Conclusion: Placement of a coronary sinus lead in patients who do not achieve adequate DFT testing with conventional lead placement results in improved defibrillation thresholds.
DOI
10.1016/S0735-1097(24)02261-7
Publication Date
4-2024
ISSN
1558-3597
Recommended Citation
Miller S, Clark C, Swartz JF. Overcoming High Defibrillation Thresholds With Placement of a Coronary Sinus Lead. Journal of the American College of Cardiology. 2024; 83(13S). doi: 10.1016/S0735-1097(24)02261-7.
