Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement: a simulation study

Figures

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  Figure 1.. Model generation and ICD setups. (A) Pipeline of generating torso models with embedded detailed cardiac models with commonly used ICD coils/cans. (B) Schematic of ICD setups assessed in this study. The RV apical coil to the left-sided can represents the conventional ICD configuration.

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  Figure 2.. Comparison between Left-sided can (pink bar) with Right-sided can (black bar) configurations (with RV apical coil) for both DFT Energy (J) and electrical impedance (Ω) in Tukey boxplots (n=20). On the right shows the extracellular potential Ve (V) distribution across the torso model (transparent outer surfaces) and on both ventricles, as well as the gradient of Ve (electric field, E (V/cm)) across both ventricles.

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  Figure 3.. Comparison of DFT Energy (J) and electrical impedance (Ω ) with ICD configurations involving an RV apical coil and right-sided can with additional “SVC coil”, “CS coil” and “both SVC and CS coils” in Tukey boxplots (n=20). Lower images show the extracellular potential Ve (V) distribution for each configuration across the torso and on both ventricles, along with the gradient of Ve (electric field, E (V/cm)) across both ventricles.

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  Figure 4.. Comparison of DFT Energy (J) and electrical impedance (Ω ) with ICD configurations involving an RV septal coil and RV apical coil on in combination with (A) right-sided can and (B) left-sided can in Tukey boxplots (n=20). Images on the right show the extracellular potential Ve (V) distribution for each configuration across the torso and on both ventricles, along with the gradient of Ve (electric field, E (V/cm)) across both ventricles.

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  Figure 5.. Comparison of DFT Energy (J) and electrical impedance (Ω) with ICD configurations involving an RV septal coil and Right-sided can with additional SVC coil, CS coil and both SVC and CS coils in Tukey boxplots (n=20). Lower images show the extracellular potential Ve (V) distribution for each configuration across the torso and on both ventricles, along with the gradient of Ve (electric field, E(V/cm)) across both ventricles.

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  Figure 6.. Comparison of DFT Energy (J) with different cardiac pathological variants separated into healthy, DCM, HCM and ICMs using ICD configurations as in Figure 2 (A), 3 (B), 4 (C, D), 5 (E).