Right Parasternal Electrode Configuration Converts a Failed Electrocardiographic Screening to a Pass for Subcutaneous Implantable Cardioverter-Defibrillator Implantation

Heart, Lung & Circulation
N Y ChanN S Mok

Abstract

Pre-operative electrocardiographic (ECG) screening before subcutaneous implantable cardioverter-defibrillator (SICD) implantation is essential to prevent T-wave oversensing and inappropriate shocks. The failure rate of ECG screening was reported to be up to 8% when only two body positions were tested. Three subcutaneous ECG vectors represented by lead I, II and III were obtained in standing, supine, sitting and squatting positions. A patient qualified if the ECG in any same lead passed in all four positions. We report a 31-year-old man with idiopathic ventricular fibrillation who failed ECG screening for SICD implantation with the conventional left parasternal electrode (LPS) configuration in all three subcutaneous ECG vectors. Right parasternal electrode (RPS) configuration with left arm and right arm ECG electrodes positioned 1cm lateral to right sternal border was attempted for screening. The amplitude of the QRS complex was significantly larger in the RPS compared to the LPS configuration in lead III and the patient passed the ECG screening in four body positions. He underwent successful SICD implantation with RPS approach with appropriate sensing both during the procedure and exercise treadmill test four weeks later. Ventr...Continue Reading

References

Jun 20, 2006·Journal of the American College of Cardiology·Matthew R ReynoldsApril W Simon
May 14, 2010·The New England Journal of Medicine·Gust H BardyAndrew A Grace
Dec 20, 2013·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·Daniel A RandlesDavid J Wright
Apr 24, 2014·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Christopher A GrohBradley P Knight

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Citations

Apr 26, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Hideo OkamuraPaul A Friedman
Dec 30, 2017·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Markus BettinLars Eckardt

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