A novel approach to eliminate intraventricular lead placement in patients with congenital heart disease.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
Nikhil GuptaKevin Shannon

Abstract

We describe two patients with congenital heart disease who were referred for implantable cardioverter-defibrillator (ICD) placement. Both patients possessed factors causing the conventional transvenous approach to be undesirable. We therefore devised a technique which circumvented both intravascular ICD lead placement, as well as placement of leads across the tricuspid valve. For both patients, a bipolar pace-sense lead was successfully placed in a branch of the coronary sinus. A shocking coil was then tunneled from the posterolateral margin of the device pocket, being positioned posterior and inferior to the cardiac silhouette. Defibrillation testing was carried out with goal of a 10-J safety margin. We were able to successfully achieve ICD implantation in both patients with complex congenital heart disease without requirement for surgical thoracotomy or a lead across the AV valve. R waves in excess of 5 mV were obtained and acceptable defibrillation characteristics were achieved. Both patients are doing well after mid-term follow-up. A new implant approach is presented, which involves minimal intravascular hardware and eliminates passage across the atrioventricular valve for patients with congenital heart disease in whom conv...Continue Reading

References

Jan 31, 2002·Pacing and Clinical Electrophysiology : PACE·C I BerulE P Walsh
Jun 25, 2005·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Grzegorz RozmusCharles Francis
Jan 13, 2006·Journal of Cardiovascular Electrophysiology·Jacques Billette, Michel Lavallée
Feb 24, 2007·Journal of Cardiovascular Electrophysiology·Mauro BiffiGiuseppe Boriani
Oct 28, 2008·Pacing and Clinical Electrophysiology : PACE·Jonas A CooperTimothy W Smith
Oct 7, 2009·Pacing and Clinical Electrophysiology : PACE·Mayurkumar BhaktaGregory T Altemose
Dec 22, 2009·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·C GrimardD Babuty
Jul 30, 2011·Journal of the American College of Cardiology·Paul MonagleUNKNOWN Fontan Anticoagulation Study Group

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Citations

Feb 2, 2015·The American Journal of Cardiology·Avishay GrupperMichael Glikson

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