Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Imaging

Background:

• Standard implantable cardioverter defibrillator (ICD) generator placement is typically left-sided.
• Right-sided ICD generator placement may be necessary in certain patients.
• Right-sided placement can potentially increase the defibrillation threshold (DFT) due to suboptimal shock vectors.

Purpose of the Study:

• To quantitatively assess the impact of right-sided ICD can placement on DFT.
• To evaluate if alternate right ventricular (RV) shocking coil positioning can mitigate increased DFT.
• To determine if adding superior vena cava (SVC) and coronary sinus (CS) coils can reduce DFT in right-sided configurations.

Main Methods:

• Utilized CT-derived torso models for assessing DFT of various ICD configurations.
• Compared DFT between left-sided and right-sided ICD can placements with apical RV shock coils.
• Evaluated DFT changes with septal RV coil positioning and the addition of SVC and CS coils.

Main Results:

• Right-sided cans significantly increased DFT by approximately 50% compared to left-sided cans (19.5 J vs. 13.3 J).
• Septal RV coil positioning further increased DFT for right-sided cans, but not for left-sided cans.
• Adding both SVC and CS coils most effectively reduced DFT for right-sided can configurations.

Conclusions:

• Right-sided ICD can placement leads to a significant increase in DFT.
• Apical RV coil positioning is preferable to septal positioning for right-sided cans to minimize DFT.
• The addition of SVC and CS coils is a viable strategy to mitigate elevated DFTs associated with right-sided ICD can placement.