Novel Use of a Vascular Plug to Anchor an Azygous Vein ICD Lead

• Published in: Journal of cardiovascular electrophysiology 2010-01, Vol.21 (1), p.99-102
• Main Authors: BAR‐COHEN, YANIV, TAKAO, CHERYL M., WELLS, WINFIELD J., SAXON, LESLIE A., CESARIO, DAVID A., SILKA, MICHAEL J.
• Format: Article
• Language: English
• Subjects: Adolescent; Blood Vessel Prosthesis; cardiac arrest; Cardiomyopathies - prevention & control; Cardiomyopathy, Hypertrophic - diagnosis; Cardiomyopathy, Hypertrophic - prevention & control; Defibrillators, Implantable; Electrodes, Implanted; Female; high defibrillation thresholds; Humans; hypertrophic cardiomyopathy; ICD; Prosthesis Implantation - instrumentation; Prosthesis Implantation - methods; Treatment Outcome
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/j.1540-8167.2009.01510.x

Vascular Plug for ICD Lead.  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. (J Cardiovasc Electrophysiol, Vol. 21, pp. 99–102, January 2010)