Implantable cardioverter-defibrillator (ICD) defibrillation testing may reveal failure
to achieve a satisfactory safety margin (conventionally, ≥10 J below the maximum energy
of the generator) for defibrillation. Options for modification of the defibrillation
threshold include repositioning of the ventricular lead, use (or removal) of a defibrillation
coil in the superior vena cava (SVC), reversal of shock polarity, and modifying the
shock waveform (not available in all devices). Additional defibrillator coils can
be added to the subcutaneous space, the subclavian vein, or the coronary sinus.
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References
- Azygous vein lead implantation: a novel adjunctive technique for implantable cardioverter defibrillator placement.J Cardiovasc Electrophysiol. 2004; 15: 780-783
- The azygous defibrillator lead for elevated defibrillation thresholds: implant technique, lead stability, and patient series.PACE. 2008; 31: 1405-1410
- Testing and programming of implantable defibrillator functions at implantation.in: Ellenbogen K.A. Kay G.N. Lau C.P. Wilkoff B.L. Clinical Cardiac Pacing, Defibrillation, and Resynchronization Therapy. Third Edition. Saunders Elsevier, Philadelphia2007: 531-557
- Shock impedance after replacing the superior vena cava coil with an azygous defibrillation lead.Heart Rhythm. 2009; 6: S33
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Article info
Publication history
Published online: July 06, 2009
Footnotes
Jonas A. Cooper is a consultant for Medtronic, Inc., and Boston Scientific. Timothy W. Smith has received research support from Medtronic, Inc., and Boston Scientific; is a speaker for Medtronic, Inc., and Boston Scientific; and is a consultant for Medtronic.
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Copyright
© 2009 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
