Abstract 13673: Biventricular Defibrillation Using Rapid, Simple Delivery of Defibrillation Coils to Coronary Sinus Branches in Patients With High Defibrillation Thresholds
Introduction: Treating patients with high defibrillation thresholds (DFT) remains a clinical challenge. Implantation of a subcutaneous or azygos vein coil increases procedural complexity and morbidity. Biventricular defibrillation has been shown to decrease DFTs up to 45%. We hypothesized that coil placement in coronary sinus(CS) branches using standard LV lead delivery tools could be useful in high DFT patients.
Methods: Four patients with high DFTs (>35J) despite optimization of RV and superior vena cava (SVC) coils underwent CS venograms and placement of a defibrillator coil in suitable LV branches using common LV lead delivery tools. Y-connectors were used to test different configurations.
Results: Coils were successfully delivered to CS branches without difficulty. All four patients were successfully defibrillated with 25J shocks using CS coils in various configurations. These included anodal RV coil in 3/4 patients and anodal RV-CS combined in 1/4 patients. Cathodal pole included combinations of can-CS (1), can-SVC (1), can-SVC-CS (1), and CS-SVC-left subclavian (1).
Conclusions: CS branches are useful and technically simple alternative sites for defibrillation coil placement and may eliminate the need for subcutaneous array placement. Further investigations comparing CS coil placement vs. subcutaneous array implantation are warranted.
- © 2011 by American Heart Association, Inc.