Implantation of Implantable Cardioverter-Defibrillators from an Ileofemoral Approach

Abstract

Patients needing an implantable cardioverter defibrillator (ICD) system, but without suitable access from jugular or subclavian routes present a vexing problem. Such patients would normally undergo thoracotomy for epicardial lead placement. However, for patients who decline such an intervention, there have been no alternatives for them. There is scarce data from the published literature addressing this dilemma. We report two cases of successful ICD and biventricular ICD placement from an ileofemoral approach.

Direct Left Ventricular Endocardial Pacing: An Alternative When Traditional Resynchronization Via Coronary Sinus Is Not Feasible or Effective

“…In two cases of complete biventricular ICD implantation via the femoral approach, we achieved good defibrillation thresholds by using the technique of proximal coil prolapse into the superior vena cava, because the energy is largely aimed at the myocardium. By using this coil position, we also avoid the risk of contact between the proximal and distal coils reported in previous papers …”

Transfemoral access when superior venous approach is not feasible equals overall success of permanent pacemaker implantation. Ten‐year series

“…The femoral access technique for the implantation of cardiac stimulation systems is used sparingly and in very few centers around the world, although series of more than 10 patients have been published for more than 35 years and show successes both in adults and children when the more usual access is problematic. In addition, success with femoral access has been reported in problematic cases involving single‐ and dual‐chamber pacemakers, automatic implantable cardiac defibrillators (AICDs) using subcutaneous patches, active can, CRT stimulation mode, and even CRT mode using an endocardial electrode in the LV with transseptal access . Nonetheless, the technique remains widely considered as a very last resort …”

Innovative Techniques for Placement of Implantable Cardioverter‐Defibrillator Leads in Patients with Limited Venous Access to the Heart

“…In 2001, there was a report of subcutaneous arrays positioned in the right and left chest walls having good defibrillation thresholds in a 2‐year‐old child with ventricular tachycardia and repaired congenital heart disease 15 . There are other reports of ICD implantation in a child using a single subcutaneous array lead and an abdominal active can 16 and implantation from an ileofemoral approach 17 . The major concern about these approaches at our institution was the potential for lead trauma and damage.…”