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Published on: February 28, 2012
Single Coil Implantable Cardioverter Defibrillator Leads in Patients With Hypertrophic Cardiomyopathy
Kartik R Kumar1, Swati N Mandleywala1, Christopher Madias1
1Hypertrophic Cardiomyopathy Institute, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts.
Insights
Single coil defibrillation leads can be adequate for hypertrophic cardiomyopathy patients needing implantable cardioverter-defibrillators (ICDs). Defibrillation testing is recommended for all hypertrophic cardiomyopathy patients receiving ICDs, especially those with single coil leads.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Patients with hypertrophic cardiomyopathy (HCM) often require higher energies for ventricular fibrillation (VF) termination.
- Dual coil defibrillation leads are commonly used, but single coil leads may be preferred for younger patients.
Purpose of the Study:
- To evaluate the efficacy and safety of single coil versus dual coil defibrillation leads in patients with hypertrophic cardiomyopathy (HCM) undergoing implantable cardioverter-defibrillator (ICD) implantation.
- To determine if single coil leads provide adequate safety margins for VF termination in this population.
Main Methods:
- Retrospective analysis of 249 HCM patients implanted with transvenous ICDs between 2000 and 2014.
- 223 patients underwent VF testing, with 150 using dual coil leads and 73 using single coil leads.
- Comparison of successful VF termination energies and safety margins between lead types.
Main Results:
- Patients with dual coil leads required lower successful VF energies (15.7 ± 6.1 J) compared to single coil leads (20.2 ± 7.9 J) (p < 0.0001).
- 97.3% of patients had adequate defibrillation safety margins.
- Six patients (4 with single coil leads) had inadequate safety margins, with 3 requiring lead replacement.
Conclusions:
- Single coil leads can provide adequate safety margins in HCM patients undergoing ICD implantation.
- Defibrillation testing is recommended for all HCM patients receiving ICDs, particularly those with single coil leads.
Abstract:
Patients with hypertrophic cardiomyopathy (HC) may require higher energies to terminate ventricular fibrillation (VF); thus, dual coil defibrillation leads are often implanted. However, single coil leads may be preferred in young patients. All patients with HCM implanted with a transvenous ICD from years 2000 to 2014 were included. Of 249 patients, 223 underwent VF testing including 150 with a dual coil lead and 73 a single coil. Patients tested with dual coil compared with single coil had lower successful VF energies (15.7 ± 6.1 joule to 20.2 ± 7.9 joule (p <0.0001)). Adequate safety margin for defibrillation was noted in 97.3% of patients. Notably, 6 (4 with single coil leads) had inadequate safety margins (defined as ≥10 joule). Three of these 6 patients required replacement of a single coil lead with a dual coil lead. The remaining 3 underwent waveform tilt alteration, higher energy ICD, or removal of the can from the shock vector. There were no clinical or implant predictors of inadequate safety margins. In follow-up of 16 ± 30 months (range 0 to 170), there were 24 arrhythmias including 13 VF, all successfully terminated. In conclusion, in HC patients undergoing ICD implantation, single coil leads can provide adequate safety margins. In conclusion, defibrillation testing should be considered in all HC patients undergoing ICD implantation, and should be performed in those undergoing implantation with a single coil lead.
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