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Coronary sinus shocking lead as salvage in patients with advanced CHF and high defibrillation thresholds

Osman Faheem1, Arun Padala, Jeffrey Kluger

  • 1Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA.

Pacing and Clinical Electrophysiology : PACE
|March 17, 2010
PubMed

Insights

For patients with advanced cardiomyopathy, a novel approach using the coronary sinus for left ventricular shocking electrode placement successfully achieved defibrillation thresholds (DFT) when standard implantable cardioverter-defibrillator (ICD) methods failed.

Area of Science:

  • Cardiology
  • Medical Devices

Background:

  • Implantable cardioverter-defibrillator (ICD) implantation can fail to achieve adequate defibrillation thresholds (DFT) in patients with advanced cardiomyopathy.
  • Standard modification and enhancement procedures were ineffective in three reported patients.

Observation:

  • Coronary sinus (CS) placement of a left ventricular (LV) shocking electrode was utilized.
  • Posterior coil positioning in the CS was employed in all three patients.
  • In two patients, the LV shocking coil was placed alongside a CS pacing lead.

Findings:

  • Acceptable DFTs were achieved in all three patients using the CS approach.
  • The optimal shocking configuration identified was LV (CS) (Anode) to RV (cathode).
  • Short- and long-term outcomes for these patients were presented and discussed.

Implications:

  • This CS lead placement strategy serves as a viable salvage option for challenging ICD implantations.
  • It addresses cases where standard methods fail to achieve adequate DFTs.
  • This technique may improve ICD implantation success rates in patients with complex cardiac conditions.
Abstract

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