Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement: a simulation study

Shuang Qian; Sofia Monaci; Caroline Mendonca-Costa; Fernando Campos; Philip Gemmell; Hassan A. Zaidi; Ronak Rajani; John Whitaker; Christopher A. Rinaldi; Martin J. Bishop

doi:10.1093/europace/euad146

Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement: a simulation study

Shuang Qian^*, Sofia Monaci, Caroline Mendonca-Costa, Fernando Campos, Philip Gemmell, Hassan A. Zaidi, Ronak Rajani, John Whitaker, Christopher A. Rinaldi, Martin J. Bishop

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Aims 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). Methods and results 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]. Conclusion 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.

Original language	English
Article number	euad146
Journal	Europace
Volume	25
Issue number	6
DOIs	https://doi.org/10.1093/europace/euad146
Publication status	Published - 1 Jun 2023

Keywords

Computational modelling
CT imaging
Defibrillation threshold
Implantable cardioverter defibrillator
Right-sided generator

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/europace/euad146

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Qian, S., Monaci, S., Mendonca-Costa, C., Campos, F., Gemmell, P., Zaidi, H. A., Rajani, R., Whitaker, J., Rinaldi, C. A., & Bishop, M. J. (2023). Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement: a simulation study. Europace, 25(6), Article euad146. https://doi.org/10.1093/europace/euad146

@article{8cfda832f63a4bd394a76abd9f911e79,

title = "Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement: a simulation study",

abstract = "Aims 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). Methods and results 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]. Conclusion 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.",

keywords = "Computational modelling, CT imaging, Defibrillation threshold, Implantable cardioverter defibrillator, Right-sided generator",

author = "Shuang Qian and Sofia Monaci and Caroline Mendonca-Costa and Fernando Campos and Philip Gemmell and Zaidi, {Hassan A.} and Ronak Rajani and John Whitaker and Rinaldi, {Christopher A.} and Bishop, {Martin J.}",

note = "Funding Information: S.Q. and M.J.B. acknowledge support from a King{\textquoteright}s Health Partners Research & Development Challenge Award via the Medical Research Council (MRC) Confidence in Concept scheme (MC_PC_18052), with additional support from the Wellcome EPSRC Centre for Medical Engineering at King{\textquoteright}s College London (WT 203148/Z/16/Z) and the NIHR Biomedical Research Centre & CRF, and the NIHR Cardiovascular MedTech Co-operative, at Guy{\textquoteright}s and St Thomas{\textquoteright} NHS Foundation Trust and King{\textquoteright}s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. This work was also supported by a Wellcome Trust Innovator Award to M.J.B. (213342/Z/18/Z) and a British heart foundation project grant (PG/18/74/34077). Publisher Copyright: {\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2023",

month = jun,

day = "1",

doi = "10.1093/europace/euad146",

language = "English",

volume = "25",

journal = "Europace",

issn = "1099-5129",

publisher = "Oxford University Press (OUP)",

number = "6",

}

TY - JOUR

T1 - Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement

T2 - a simulation study

AU - Qian, Shuang

AU - Monaci, Sofia

AU - Mendonca-Costa, Caroline

AU - Campos, Fernando

AU - Gemmell, Philip

AU - Zaidi, Hassan A.

AU - Rajani, Ronak

AU - Whitaker, John

AU - Rinaldi, Christopher A.

AU - Bishop, Martin J.

N1 - Funding Information: S.Q. and M.J.B. acknowledge support from a King’s Health Partners Research & Development Challenge Award via the Medical Research Council (MRC) Confidence in Concept scheme (MC_PC_18052), with additional support from the Wellcome EPSRC Centre for Medical Engineering at King’s College London (WT 203148/Z/16/Z) and the NIHR Biomedical Research Centre & CRF, and the NIHR Cardiovascular MedTech Co-operative, at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. This work was also supported by a Wellcome Trust Innovator Award to M.J.B. (213342/Z/18/Z) and a British heart foundation project grant (PG/18/74/34077). Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2023/6/1

Y1 - 2023/6/1

N2 - Aims 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). Methods and results 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]. Conclusion 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.

AB - Aims 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). Methods and results 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]. Conclusion 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.

KW - Computational modelling

KW - CT imaging

KW - Defibrillation threshold

KW - Implantable cardioverter defibrillator

KW - Right-sided generator

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U2 - 10.1093/europace/euad146

DO - 10.1093/europace/euad146

M3 - Article

C2 - 37314196

AN - SCOPUS:85163905372

SN - 1099-5129

VL - 25

JO - Europace

JF - Europace

IS - 6

M1 - euad146

ER -

Additional coils mitigate elevated defibrillation threshold in right-sided implantable cardioverter defibrillator generator placement: a simulation study

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Keywords

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