Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy

• Published in: Circulation Journal 2016/09/23, Vol.80(10), pp.2199-2203
• Main Authors: Okamura, Hideo, Friedman, Paul A., Inoue, Yuko, Noda, Takashi, Aiba, Takeshi, Yasuda, Satoshi, Ogawa, Hisao, Kamakura, Shiro, Kusano, Kengo, Espinosa, Raul E.
• Format: Article
• Language: English
• Subjects: Aged; Cardiomyopathy, Hypertrophic - physiopathology; Cardiomyopathy, Hypertrophic - therapy; Defibrillation threshold; Defibrillators, Implantable; Female; Humans; Hypertrophic cardiomyopathy; Implantable cardioverter-defibrillator; Male; Middle Aged; Safety; Single-coil leads; Ventricular Fibrillation - physiopathology; Ventricular Fibrillation - therapy
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-16-0428

Background:Single-coil defibrillator leads have gained favor because of their potential ease of extraction. However, a high defibrillation threshold remains a concern in patients with hypertrophic cardiomyopathy (HCM), and in many cases, dual-coil leads have been used for this patient group. There is little data on using single-coil leads for HCM patients.Methods and Results:We evaluated 20 patients with HCM who received an implantable cardioverter-defibrillator (ICD) on the left side in combination with a dual-coil lead. Two sets of defibrillation tests were performed in each patient, one with the superior vena cava (SVC) coil “on” and one with the SVC coil “off”. ICDs were programmed to deliver 25 joules (J) for the first attempt followed by maximum energy (35 J or 40 J). Shock impedance and shock pulse width at 25 J in each setting as well as the results of the shock were analyzed. All 25-J shocks in both settings successfully terminated ventricular fibrillation. However, shock impedance and pulse width increased substantially with the SVC coil programmed “off” compared with “on” (66.4±6.1 ohm and 14.0±1.3 ms “off” vs. 41.9±5.0 ohm and 9.3±0.8 ms “on”, P