Journal Information
Vol. 31. Issue 4.
Pages 321-322 (April 2012)
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
Visits
9906
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
This item has received

Under a Creative Commons license
Article information
Full Text
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text

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
Download PDF
Idiomas
Revista Portuguesa de Cardiologia (English edition)
Article options
Tools
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.