Significance of intraoperative testing in right-sided implantable cardioverter-defibrillators

Abstract

BackgroundImplantation of implantable cardioverter-defibrillators (ICD) from the left pectoral region is the standard therapeutical method. Increasing numbers of system revisions due to lead dysfunction and infections will consecutively increase the numbers of right-sided implantations. The reliability of devices implanted on the right pectoral side remains controversially discussed, and the question of testing these devices remains unanswered.MethodsIn a prospectively designed study all 870 patients (60.0±14 years, 689 male) who were treated with a first ICD from July 2005 until May 2012 and tested intraoperatively according to the testing protocol were analyzed. The indication for implantation was primary prophylactic in 71.5%. Underlying diseases included ischemic cardiomyopathy (50%), dilative cardiomyopathy (37%), and others (13%). Mean ejection faction was 27±12%. Implantation site was right in 4.5% and left in 95.5%.ResultsFive patients supplied with right-sided ICD (13%, p = 0.02 as compared to left-sided) failed initial intraoperative testing with 21 J. 3 patients were male. The age of the patients failing intraoperative testing with right-sided devices appeared higher than of patients with left-sided devices (p = 0.07). The ejection fraction was 28±8%. All patients reached a sufficient DFT ≤ 21 J after corrective procedures.ConclusionImplantation of ICDs on the right side results in significantly higher failure rate of successful termination of intraoperatively induced ventricular fibrillation. The data of our study suggest the necessity of intraoperative ICD testing in right-sided implanted ICDs.

Implantation of a Dual-Chamber Automatic Cardioverter Defibrillator in a Patient with Persistent Left Superior Vena Cava: Case Report and Brief Literature Review

“…Crossing on the right side implies venographic confirmation of RSVC, an additional puncture and increased risk of pneumothorax and increase postprocedural discomfort in right-handed patients. In case of cardioverter defibrillators, right side placement might reduce the efficiency of defibrillation therapies, requiring defibrillation threshold testing [ 23 ]. As a result, there are case reports in which right sided approach was used for lead placement, and the lead was connected to the left side defibrillator pocket through subcutaneous tunneling [ 4 , 20 ].…”

Cardiac resynchronization therapy coronary venous left ventricular lead removal and reimplantation: Experience from a single center in China

“…A total of 8 of these patients were reimplanted with CRT/CRTD on the right side following removal. Several studies have suggested that although the defibrillation threshold may be elevated in the right implantable cardiac defibrillator (ICD) compared with that noted in the left ICD, it is still considered safe and effective in clinical applications (10)(11)(12).…”

Balloon venoplasty opens the road for an implantable defibrillator patient with complex stenosis

“…While pacemakers have been routinely implanted from the right side, right‐sided ICD implants are much rarer. For one thing, ICDs are larger and bulkier which can complicate a right‐sided implant, and more importantly, right‐sided ICD implantation can alter the shocking vector in such a way that increases the defibrillation threshold .…”