Determinants of Subcutaneous Implantable Cardioverter-Defibrillator Efficacy: A Computer Modeling Study

JACC. Clinical Electrophysiology
E Kevin HeistReinoud E Knops

Abstract

This study determined the impact of subcutaneous implantable cardioverter-defibrillator (S-ICD) coil and generator position on defibrillation threshold (DFT). S-ICD implantation can occasionally result in unacceptably high DFT. Implant position characteristics associated with high DFTs in S-ICD patients have not been fully elucidated. A 3.8-million-element computer model built from magnetic resonance images was used to simulate the electric fields that occur during defibrillation. Generator positions were tested from posterior to anterior in 4-cm increments. The left parasternal coil was tested with 0, 5, and 10 mm of underlying subcutaneous fat and the generator with 20 mm of underlying fat. The estimated DFT for the S-ICD was defined as the energy delivered when producing an electric field of 4 volts/cm in at least 95% of the ventricular myocardium. Estimated DFTs were 22, 29, 64, and 135 joules for posterior, standard (lateral), mid-anterior, and anterior generator locations, respectively. Defibrillation thresholds were 29, 58, and 95 joules with 0, 5, and 10 mm subcoil fat, respectively, and 45 joules with 20 mm subgenerator fat. Combining anterior generator position with subcoil fat resulted in a very high DFT (379 joules)...Continue Reading

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Citations

Aug 10, 2019·Pacing and Clinical Electrophysiology : PACE·Beatriz León SalasPedro Serrano-Aguilar
Dec 28, 2018·Arrhythmia & Electrophysiology Review·Justin HayaseNoel G Boyle
Jul 29, 2020·Pacing and Clinical Electrophysiology : PACE·Willeke van der StuijtReinoud E Knops
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Nov 26, 2020·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·Lucas V A Boersma
Nov 17, 2020·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·Willeke van der StuijtReinoud E Knops
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Aug 19, 2021·Journal of Cardiovascular Electrophysiology·Mariano RilloLuigi My

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