IMPLANTATION OF AN ICD AND DFT TESTING IN PATIENT WITH PERSISTENT LEFT SUPERIOR VENA CAVA

Abstract

Aim. The implantable cardioverter-defibrillator [ICD] has been proven to reduce the risk of sudden cardiac death through the termination of ventricular fibrillation and life-threatening ventricular tachycardia. The simplest measure of defibrillation effectiveness is the DFT, defined as the lowest delivered shock strength required to defibrillate. Improved technology and use of ICDs for primary prevention have led some to question the need for either defibrillation testing or any assessment of defibrillation efficacy after implantation. Experts disagree about optimal testing because data are insufficient to define the trade-off between accuracy and risk of testing. However there are specific cases in which DFT is necessary.Material and methods. Authors describe the case of a patient with persistent left vena cava, a rare congenital anomaly, with no clinical importance which is usually accidentally revealed during the implantation of pacemaker or when placing a central vascular catheter. However, it represents a major problem and challenge for positioning of the standard pacemaker electrodes.Results. After a successful implantation via unconventional anatomic path authors carried out DFT testing to check that the device is functioning appropriately.Conclusion. Persistent left vena cava should not represent a contraindication for implantation of complex pacemaker systems such as ICD and DFT testing is advisable in this cases.

Keywords

• implantable cardioverter-defibrillator
• defibrillation threshold testing
• persistent left superior vena cava