How to implant a defibrillation coil in the azygous vein

      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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