PDF(Pubmed)
Abstract：
The standard implantable cardioverter defibrillator (ICD) generator (can) is placed in the left pectoral area; however, in certain circumstances, right-sided cans may be required which may increase defibrillation threshold (DFT) due to suboptimal shock vectors. We aim to quantitatively assess whether the potential increase in DFT of right-sided can configurations may be mitigated by alternate positioning of the right ventricular (RV) shocking coil or adding coils in the superior vena cava (SVC) and coronary sinus (CS).
A cohort of CT-derived torso models was used to assess DFT of ICD configurations with right-sided cans and alternate positioning of RV shock coils. Efficacy changes with additional coils in the SVC and CS were evaluated. A right-sided can with an apical RV shock coil significantly increased DFT compared to a left-sided can [19.5 (16.4, 27.1) J vs. 13.3 (11.7, 19.9) J, P < 0.001]. Septal positioning of the RV coil led to a further DFT increase when using a right-sided can [26.7 (18.1, 36.1) J vs. 19.5 (16.4, 27.1) J, P < 0.001], but not a left-sided can [12.1 (8.1, 17.6) J vs. 13.3 (11.7, 19.9) J, P = 0.099). Defibrillation threshold of a right-sided can with apical or septal coil was reduced the most by adding both SVC and CS coils [19.5 (16.4, 27.1) J vs. 6.6 (3.9, 9.9) J, P < 0.001, and 26.7 (18.1, 36.1) J vs. 12.1 (5.7, 13.5) J, P < 0.001].
Right-sided, compared to left-sided, can positioning results in a 50% increase in DFT. For right-sided cans, apical shock coil positioning produces a lower DFT than septal positions. Elevated right-sided can DFTs may be mitigated by utilizing additional coils in SVC and CS.
A cohort of CT-derived torso models was used to assess DFT of ICD configurations with right-sided cans and alternate positioning of RV shock coils. Efficacy changes with additional coils in the SVC and CS were evaluated. A right-sided can with an apical RV shock coil significantly increased DFT compared to a left-sided can [19.5 (16.4, 27.1) J vs. 13.3 (11.7, 19.9) J, P < 0.001]. Septal positioning of the RV coil led to a further DFT increase when using a right-sided can [26.7 (18.1, 36.1) J vs. 19.5 (16.4, 27.1) J, P < 0.001], but not a left-sided can [12.1 (8.1, 17.6) J vs. 13.3 (11.7, 19.9) J, P = 0.099). Defibrillation threshold of a right-sided can with apical or septal coil was reduced the most by adding both SVC and CS coils [19.5 (16.4, 27.1) J vs. 6.6 (3.9, 9.9) J, P < 0.001, and 26.7 (18.1, 36.1) J vs. 12.1 (5.7, 13.5) J, P < 0.001].
Right-sided, compared to left-sided, can positioning results in a 50% increase in DFT. For right-sided cans, apical shock coil positioning produces a lower DFT than septal positions. Elevated right-sided can DFTs may be mitigated by utilizing additional coils in SVC and CS.
摘要：
目的：标准的植入式心律转复除颤器（ICD）发生器（can）放置在左胸区；但是，在某些情况下,可能需要右侧罐,其可由于次优电击向量而增加除颤阈值(DFT)。我们旨在定量评估是否可以通过右心室（RV）电击线圈的替代定位或在上腔静脉（SVC）和冠状窦（CS）中添加线圈来减轻右侧罐配置的DFT的潜在增加。
结果：一组CT衍生的躯干模型用于评估带有右侧罐的ICD配置的DFT和右心室电击线圈的替代定位。评估SVC和CS中额外线圈的功效变化。与左侧罐相比，带有根尖RV电击线圈的右侧罐的DFT显着增加[19.5（16.4，27.1）J与13.3(11.7,19.9)J,P<0.001]。使用右侧罐[26.7（18.1，36.1）Jvs.19.5(16.4,27.1)J,P<0.001],但不是左侧罐[12.1（8.1，17.6）Jvs.13.3(11.7,19.9)J,P=0.099)。通过同时添加SVC和CS线圈，具有根尖或间隔线圈的右侧罐的除颤阈值降低最大[19.5（16.4，27.1）Jvs.6.6(3.9,9.9)J,P<0.001，26.7（18.1，36.1）J与12.1(5.7,13.5)J,P<0.001]。
结论：右侧，与左侧相比，可以定位导致DFT增加50%。对于右侧罐，根尖电击线圈定位产生比间隔位置更低的DFT。可以通过利用SVC和CS中的附加线圈来减轻升高的右侧罐DFT。
结果：一组CT衍生的躯干模型用于评估带有右侧罐的ICD配置的DFT和右心室电击线圈的替代定位。评估SVC和CS中额外线圈的功效变化。与左侧罐相比，带有根尖RV电击线圈的右侧罐的DFT显着增加[19.5（16.4，27.1）J与13.3(11.7,19.9)J,P<0.001]。使用右侧罐[26.7（18.1，36.1）Jvs.19.5(16.4,27.1)J,P<0.001],但不是左侧罐[12.1（8.1，17.6）Jvs.13.3(11.7,19.9)J,P=0.099)。通过同时添加SVC和CS线圈，具有根尖或间隔线圈的右侧罐的除颤阈值降低最大[19.5（16.4，27.1）Jvs.6.6(3.9,9.9)J,P<0.001，26.7（18.1，36.1）J与12.1(5.7,13.5)J,P<0.001]。
结论：右侧，与左侧相比，可以定位导致DFT增加50%。对于右侧罐，根尖电击线圈定位产生比间隔位置更低的DFT。可以通过利用SVC和CS中的附加线圈来减轻升高的右侧罐DFT。
