Successful reduction of a high defibrillation threshold by a combined implantation of a subcutaneous array and azygos vein lead.

Abstract

A 72-year-old man with nonischemic cardiomyopathy was referred because his implantable cardioverter defibrillator had failed to terminate spontaneous ventricular fibrillation (VF). Defibrillation threshold (DFT) testing confirmed that 830-V shocks failed to defibrillate VF despite optimization of the biphasic waveform and reversal of shock polarity. The placement of a new right ventricular lead and the addition of a subcutaneous array failed to defibrillate VF at 830 V. The combination of a subcutaneous array and azygos vein coil successfully defibrillated VF. The mechanism for successful DFT reduction was likely greater current supplied to the posterior basal left ventricle by the azygos vein lead.

• Authors: Takumi Yamada, Peter G Robertson, H Thomas McElderry, Harish Doppalapudi, Vance J Plumb, G Neal Kay
• Journal: Pacing and clinical electrophysiology : PACE (Pacing Clin Electrophysiol) Vol. 35 Issue 6 Pg. e173-6 (Jun 2012) ISSN: 1540-8159 [Electronic] United States
• PMID: 22360586 (Publication Type: Case Reports, Journal Article)
• Copyright: ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

Topics

• Aged
• Azygos Vein (surgery)
• Defibrillators, Implantable
• Differential Threshold
• Electric Countershock (instrumentation, methods)
• Electrodes, Implanted
• Humans
• Male
• Prosthesis Implantation (methods)
• Ventricular Fibrillation (prevention & control)