J Korean Med Sci.  2010 Oct;25(10):1526-1528. 10.3346/jkms.2010.25.10.1526.

Use of a Tunneling Technique to Achieve a Lower Defibrillation Threshold during Implantable Cardioverter Defibrillator Implantation via the Right Subclavian Vein

• Kim JB
• Joung B
• Lee MH
• Kim SS

• KMID: 2157861
• DOI: http://doi.org/10.3346/jkms.2010.25.10.1526

Abstract

A 56-yr-old man with aborted sudden cardiac death underwent implantable cardioverter defibrillator (ICD) implantation. While the ICD was being implanted, a left subclavian venogram failed to visualize the left subclavian vein, which was attributed to likely prolonged indwelling of the left subclavian sheath for venous access. Accordingly, the right subclavian vein was punctured and the ICD lead was diverted from the right side area to the active Can in the left pectoral area by tunneling over the sternum for high defibrillation threshold. The approach used in this case may be considered in patients who had difficult left subclavicular venous access and it may be prudent to save the left subclavian vein for ICD implantation in patients with fatal tachyarrhythmia.

Keyword

Defibrillators, Implantable; Electric Countershock

MeSH Terms

Coronary Angiography
Death, Sudden, Cardiac/prevention & control
*Defibrillators, Implantable
Electric Countershock
Electrocardiography
Heart Rate
Humans
Male
Middle Aged
Stents
Subclavian Vein/*surgery
Tachycardia, Ventricular/therapy

Figure

• 

  Fig. 1 Venogram showed no visible left subclavian vein due to total occlusion of left subclavian vein after prolonged catheter indwelling (arrows).

• 

  Fig. 2 (A) Chest PA after ICD implantation. Arrowheads indicate ICD lead. (B) Left lateral view after ICD implantation.

Reference

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