Document Detail


Innovative techniques for placement of implantable cardioverter-defibrillator leads in patients with limited venous access to the heart.
MedLine Citation:
PMID:  16492305     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Because of venous occlusion, intracardiac shunting, previous surgery, or small size placement of implantable cardioverter-defibrillator (ICD) leads may not be possible using traditional methods. The purpose of this study was to evaluate and describe innovative methods of placing ICD leads. METHODS: The records of all patients undergoing ICD implantation at our institution were reviewed to identify patients with nontraditional lead placement. Indications for ICD, method of lead and coil placement, defibrillation thresholds, complications, and follow-up results were reviewed retrospectively. RESULTS: Eight patients (aged 11 months to 29 years) were identified. Six patients with limited venous access to the heart (four extracardiac Fontan, one bidirectional Glenn, one 8 kg 11-month-old) underwent surgical placement of an ICD coil directly into the pericardial sac. A second bipolar lead was placed on the ventricle for sensing and pacing. Two patients with difficult venous access had a standard transvenous ICD lead inserted directly into the right atrium (transatrial approach) and then positioned into the ventricle. All patients had a defibrillation threshold of <20 J, although one patient required placement of a second coil due to an elevated threshold. There have been no complications and two successful appropriate ICD discharges at follow-up (median 22 months, range 5-42 months). CONCLUSIONS: Many factors may prohibit transvenous ICD lead placement. Nontraditional surgical placement of subcutaneous ICD leads on the pericardium or the use of a transatrial approach can be effective techniques in these patients. These procedures can be performed at low risk to the patient with excellent defibrillation thresholds.
Authors:
Bryan C Cannon; Richard A Friedman; Arnold L Fenrich; Charles D Fraser; E Dean McKenzie; Naomi J Kertesz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  29     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-22     Completed Date:  2006-08-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  181-7     Citation Subset:  IM    
Affiliation:
Division of Pediatrics, Section of Cardiology, Baylor College of Medicine, Texas Childrens Hospital, Houston, Texas, USA. bcannon@bcm.tmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Constriction, Pathologic
Coronary Vessel Anomalies*
Defibrillators, Implantable*
Female
Heart Catheterization / methods*
Humans
Infant
Male
Subclavian Vein
Thoracotomy / methods
Treatment Outcome
Vena Cava, Superior

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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