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Failed Maximal Defibrillation Threshold Testing in the Subcutaneous Implantable Cardioverter Defibrillator
Joshua D Levine1, Catherine Ellins, Nancy Winn
1University of Florida Health Science Center, Jacksonville, Fla., USA.
Cardiology
|August 23, 2016
Summary
Subcutaneous implantable cardioverter-defibrillators (S-ICD) pose challenges in obese patients. This case highlights component migration and defibrillation threshold testing difficulties in a patient with a BMI of 44.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- The Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) is an option for sudden cardiac death prevention.
- Limited data exists for S-ICD implantation in patients with obesity (BMI > 40).
Observation:
- A case of a 40-year-old male with a BMI of 44 and reduced ejection fraction (25%) undergoing S-ICD implantation.
- Initial defibrillation threshold (DFT) testing failed; component migration was observed on radiography despite fluoroscopic guidance.
Findings:
- Repositioning components led to inconsistent DFT testing results.
- Obesity presents unique challenges for S-ICD implantation and device efficacy.
Implications:
- This case underscores the need for careful patient selection and procedural technique in obese individuals receiving S-ICDs.
- Further research is needed to optimize S-ICD performance and implantation strategies in the obese population.
