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Vol. 31. Issue 4.
Pages 321-322 (April 2012)
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Vol. 31. Issue 4.
Pages 321-322 (April 2012)
Image in cardiology
Open Access
Cardioverter-defibrillator with an additional subcutaneous electrode array
Cardiodesfibrilhador implantável com elétrodo de choque subcutâneo adicional
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Bruno Cordeiro Piçarraa,??
Corresponding author
bcpicarra@hotmail.com

Corresponding author.
, Pedro Silva Cunhab, Mário Oliveirab, Manuel Nogueira da Silvab, José Manuel Conceiçãob, Rui Cruz Ferreirab
a Serviço de Cardiologia, Hospital do Espírito Santo, Évora, Portugal
b Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal
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Defibrillation tests during implantation of a cardioverter-defibrillator (ICD) assess the device's effectiveness in detection and termination of ventricular fibrillation (VF). An appropriate safety margin is considered to be 10J above the minimum value tested, but the utility of such tests in the context of primary prevention has recently been called into question by various authors.

We present images from a patient who required implantation of an additional subcutaneous electrode array in the left hemithorax due to the device's failure to terminate VF during defibrillation testing, a situation that is now rarely encountered.

A 60-year-old male patient had a history of hypertension and extensive anterior myocardial infarction (MI) in 1997. Six years after the MI and following an episode of syncope, he was diagnosed with monomorphic ventricular tachycardia, with an R–R interval of 320ms. The echocardiogram revealed a dilated left ventricle with non-thickened walls, impaired global systolic function (ejection fraction of 35%), and apical dyskinesia, akinesia of the mid segments and hypokinesia of the basal segments of the anterior wall and anterior septum. Cardiac catheterization showed chronic occlusion of the proximal left anterior descending artery and 25% stenosis of the proximal circumflex. A Guidant® MINI II ICD was implanted for secondary prevention. High defibrillation thresholds were observed during ICD implantation, requiring implantation of an additional subcutaneous electrode array to enlarge the area of shock application (Figures 1–3).

Figure 1.

Posteroanterior chest X-ray. The yellow arrows indicate the subcutaneous electrode array and the red arrow indicates the intracavitary electrode.

(0.07MB).
Figure 2.

Left lateral chest X-ray. The arrows indicate the subcutaneous electrode array.

(0.05MB).
Figure 3.

Right lateral chest X-ray. The yellow arrows indicate the subcutaneous electrode array and the red arrows indicate the intracavitary electrode.

(0.06MB).

In 2002, the patient underwent elective generator replacement due to battery depletion, a CPI Prizm 2 VR ICD being implanted, and defibrillation tests were successful with a 20-J shock.

Conflicts of interest

The authors have no conflicts of interest to declare.

Please cite this article as: Cordeiro Piçarra, B. Cardiodesfibrilhador implantável com elétrodo de choque subcutâneo adicional. Rev Port Cardiol. 2012. doi:10.1016/j.repc.2012.02.006.

Copyright © 2011. Sociedade Portuguesa de Cardiologia
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Revista Portuguesa de Cardiologia (English edition)

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