Azygous Vein Coil Implantation in Left Ventricular Assist Device Patients: A Hands-on Approach

Recently, there have been reports of left ventricular assist device (LVAD) patients presenting with multiple ineffective implantable cardioverter-defibrillator (ICD) shocks. In such patients, the placement of an azygous vein coil by providing an alternative anteroposterior trajectory of the electrical shock vector can enable successful defibrillation. This review discusses a hands-on approach to azygous vein coil implantation. Additionally, we compare our tools and technique to those that have been previously described by other operators. From 2018 to 2021, eight patients were identified who underwent azygous vein coil implantation at MedStar Washington Hospital Center using a specific technique and tools. Demographic and procedural data were obtained by a retrospective review of patient charts, procedure logs, fluoroscopy, and venography performed during coil implantation. The indication for azygous vein coil implantation was ineffective ICD shocks in seven patients. The presenting rhythm was ventricular fibrillation in six (75%) cases and sustained ventricular tachycardia in two (25%) cases. Using the approach described, we were able to successfully implant an azygous vein coil in all eight (100%) patients. There were no procedure-related complications. Postimplantation, defibrillation threshold (DFT) testing was successfully performed in six of eight (75%) patients. One patient failed DFT testing despite placement of an azygous vein coil. In another patient, DFT testing was not performed because the patient was in atrial fibrillation and was not systemically anticoagulated. In conclusion, the placement of an azygous vein coil in LVAD patients with failed ICD shocks using the tools and technique described in this report is safe and highly efficacious (successful in 100% of cases).