Key result
Connecting a DF4 ICD lead to the quadripolar LV port of a CRT-P and the bipolar LV lead to the RV pacing port successfully enabled a CRT-D to CRT-P downgrade in a Boston Scientific system.
Case Report (n=1)
Provides a novel workaround for downgrading a CRT-D to a CRT-P system in patients with a DF4 ICD lead and bipolar/unipolar LV lead, overcoming the lack of a commercially available DF4 to DF1 adapter.
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May enable adapter-free CRT-D to CRT-P downgrade in select Boston Scientific patients; leaves open need for safety data and validation before practice change.
Key Teaching Points•The decision to replace or downgrade a cardiac resynchronization therapy–defibrillator (CRT-D) system upon reaching battery depletion status carries important considerations, especially in patients who have benefited from cardiac resynchronization therapy but have not experienced ventricular tachyarrhythmias.•There is currently no commercially available DF4 to DF1 adapter, which limits the ability to downgrade a CRT-D to a cardiac resynchronization therapy–pacemaker (CRT-P) system, which uses a DF4 implantable cardioverter–defibrillator (ICD) lead.•We present a case report of connecting a DF4 ICD lead to the quadripolar left ventricular (LV) port of a CRT-P and the bipolar LV lead to the right ventricular pacing port in a Boston Scientific system.•This approach is limited to bipolar and unipolar LV leads and does not apply to quadripolar leads. •The decision to replace or downgrade a cardiac resynchronization therapy–defibrillator (CRT-D) system upon reaching battery depletion status carries important considerations, especially in patients who have benefited from cardiac resynchronization therapy but have not experienced ventricular tachyarrhythmias.•There is currently no commercially available DF4 to DF1 adapter, which limits the ability to downgrade a CRT-D to a cardiac resynchronization therapy–pacemaker (CRT-P) system, which uses a DF4 implantable cardioverter–defibrillator (ICD) lead.•We present a case report of connecting a DF4 ICD lead to the quadripolar left ventricular (LV) port of a CRT-P and the bipolar LV lead to the right ventricular pacing port in a Boston Scientific system.•This approach is limited to bipolar and unipolar LV leads and does not apply to quadripolar leads.
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Giedrimas et al. (2018) conducted a case report in Cardiac resynchronization therapy-defibrillator (CRT-D) battery depletion (n=1). Connecting a DF4 ICD lead to the quadripolar LV port of a CRT-P and the bipolar LV lead to the RV pacing port was evaluated. Connecting a DF4 ICD lead to the quadripolar LV port of a CRT-P and the bipolar LV lead to the RV pacing port successfully enabled a CRT-D to CRT-P downgrade in a Boston Scientific system.
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