Defibrillator coil lead placement in the middle cardiac vein was successfully achieved in 100% (6/6) of patients with contraindicated RV lead placement, with no late complications at 60 months.
Case Report (n=6)
Does defibrillator coil lead placement in the middle cardiac vein provide safe and effective pacing and defibrillation in patients after tricuspid valve surgery with contraindicated RV lead placement?
Defibrillator coil lead placement in the middle cardiac vein is a safe and feasible alternative to epicardial lead placement via thoracotomy in patients with prior tricuspid valve surgery and contraindicated RV lead placement.
AIMS: Pacing and defibrillation with an implantable cardioverter defibrillator (ICD) after tricuspid valve surgery can be challenging if right ventricular (RV) lead placement is contraindicated or safe lead placement in the RV apex is impossible. METHODS AND RESULTS: In six patients for whom RV lead placement and repeat thoracotomy were contraindicated, ventricular pacing and sensing were achieved with bipolar leads placed in the lateral branch of the coronary sinus or in the atrialized portion of the RV or without helix exposure of the pace-sense electrodes of the defibrillator leads. After cannulation of the middle cardiac vein (MCV), a defibrillator coil lead was delivered there and placed in the farthest apical position. An 'active can' pulse generator was implanted in the left retromammary region. Biphasic shocks were delivered between the MCV coil, SVC coil, and the 'active can', or between the MCV coil, azygous vein coil, and the 'active can'. All six patients underwent successful implantation. All patients had a defibrillation safety margin of at least 10 J (at least two successful shocks at 25 J). During follow-up, one patient received a successful internal shock for ventricular fibrillation, and two received successful overdrive ventricular pacing for ventricular tachycardia. Three patients underwent defibrillation threshold testing to evaluate safety margins. No late complications have been reported at 60 months' follow-up. CONCLUSION: Defibrillator coil lead placement in the MCV is a safe alternative to epicardial lead placement via a thoracotomy in selected patients for whom RV lead placement is contraindicated or impossible.
José A. López (Tue,) conducted a case report in Patients requiring ICD after tricuspid valve surgery with contraindicated RV lead placement (n=6). Defibrillator coil lead placement in the middle cardiac vein (MCV) was evaluated on Successful implantation and defibrillation safety margin. Defibrillator coil lead placement in the middle cardiac vein was successfully achieved in 100% (6/6) of patients with contraindicated RV lead placement, with no late complications at 60 months.