Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy

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  • Okamura Hideo
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Division of Cardiovascular Diseases, Mayo Clinic
  • Friedman Paul A.
    Division of Cardiovascular Diseases, Mayo Clinic
  • Inoue Yuko
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Noda Takashi
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Aiba Takeshi
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Yasuda Satoshi
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Ogawa Hisao
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Kamakura Shiro
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Kusano Kengo
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Espinosa Raul E.
    Division of Cardiovascular Diseases, Mayo Clinic

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<p>Background:Single-coil defibrillator leads have gained favor because of their potential ease of extraction. However, a high defibrillation threshold remains a concern in patients with hypertrophic cardiomyopathy (HCM), and in many cases, dual-coil leads have been used for this patient group. There is little data on using single-coil leads for HCM patients.</p><p>Methods and Results:We evaluated 20 patients with HCM who received an implantable cardioverter-defibrillator (ICD) on the left side in combination with a dual-coil lead. Two sets of defibrillation tests were performed in each patient, one with the superior vena cava (SVC) coil “on” and one with the SVC coil “off”. ICDs were programmed to deliver 25 joules (J) for the first attempt followed by maximum energy (35 J or 40 J). Shock impedance and shock pulse width at 25 J in each setting as well as the results of the shock were analyzed. All 25-J shocks in both settings successfully terminated ventricular fibrillation. However, shock impedance and pulse width increased substantially with the SVC coil programmed “off” compared with “on” (66.4±6.1 ohm and 14.0±1.3 ms “off” vs. 41.9±5.0 ohm and 9.3±0.8 ms “on”, P<0.0001 respectively).</p><p>Conclusions:Biphasic 25-J shocks with the SVC coil ‘off’ successfully terminated ventricular fibrillation in HCM patients, indicating a satisfactory safety margin for 35-J devices. Single-coil leads appear appropriate for left-sided implantation in this patient group. (Circ J 2016; 80: 2199–2203)</p>

Journal

  • Circulation Journal

    Circulation Journal 80 (10), 2199-2203, 2016

    The Japanese Circulation Society

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