Why the study?
Does the use of a vascular plug to anchor an azygous vein ICD lead improve lead stability and defibrillation thresholds in a patient with hypertrophic cardiomyopathy?
Does the use of a vascular plug to anchor an azygous vein ICD lead improve lead stability and defibrillation thresholds in a patient with hypertrophic cardiomyopathy?
A vascular plug can be used as a novel anchor for an azygous vein ICD lead to ensure stable positioning and adequate defibrillation.
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May support vascular plug anchoring in select ICD cases; leaves open prospective validation in hypertrophic cardiomyopathy.
We describe the case of a young patient with severe hypertrophic cardiomyopathy and marginal defibrillation thresholds (DFTs) at implant of a standard transvenous implantable cardioverter-defibrillator (ICD) system. The patient subsequently experienced multiple failed ICD shocks during a prolonged episode of spontaneous ventricular tachycardia/fibrillation. Placement of a second single-coil shocking lead in the azygous vein resulted in acceptable DFTs, but the new lead migrated superiorly within hours of the procedure. To stabilize the lead position, a vascular plug was placed in the distal azygous vein, and the shocking lead screw was actively fixated to the meshwork of the device. Subsequent testing confirmed both adequate defibrillation and stable lead position.
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Bar‐Cohen et al. (2009) studied this question.
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