Premium
Defibrillation Thresholds are Increased by Right‐Sided Implantation of Totally Transvenous Implantable Cardioverter Defibrillators
Author(s) -
FRIEDMAN PAUL A.,
RASMUSSEN MARY JANE,
GRICE SUELLEN,
TRUSTY JANE,
GLIKSON MICHAEL,
STANTON MARSHALL S.
Publication year - 1999
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1999.tb00599.x
Subject(s) - medicine , venous access , cardiology , implantable cardioverter defibrillator , defibrillation , lead (geology) , surgery , catheter , geomorphology , geology
Whether an ICD is placed via a left‐ or right‐sided approach depends on venous access, the presence of a preexisting pacemaker, and other factors. Since the DFT is affected by lead position, which in turn is determined in part by the side of access, right‐sided venous access could adversely affect DFTs. Furthermore, right‐sided active can placement directs electric current toward the right hemithorax, which could further increase DFTs. This study sought to determine whether DFTs were increased by right‐sided vascular access, and whether active can technology was beneficial or detrimental with right‐sided ICD placement. Stepdown to failure DFTs were found in 290 patients receiving transvenous systems at the time of initial ICD implantation. Of these, 271 (93%) received left‐sided systems and 19 (7%) received right‐sided systems. The mean DFT in systems placed via left‐sided vascular access was 11.3 ± 5.3 J versus 17.0 ± 4.9 J for right‐sided implantation (P < 0.0001); right‐sided DFTs were elevated for both active can and cold can systems. Right‐sided active can devices had a lower DFT than right‐sided cold can systems (15 ± 4.1 J vs 19 ± 4.8 J, P = 0.05). The right‐sided implantation of implantable defibrillators results in significantly higher DFTs than the left‐sided approach. This may be due to the less favorable distribution of the defibrillating field relative to the myocardium with the devices on the right. When right‐sided implantation is clinically mandated, active can devices result in lower thresholds and should be used.