A new approach in cardioverter-defibrillator implantation in patients with coronary artery disease

Aim. Defibrillation lead implantation technique optimization using cardiac scintigraphy in patients with coronary artery disease (CAD).

Material and methods. In this study 81 patients (male — 72, age 64,0±8,7 years with CAD and indications for the cardioverter-defibrillator (ICD) implantation were examined. Patients were divided into two groups. In 1-st group before ICD implantation, patients underwent cardiac 99mTc-methoxy-isobutyl-isonitrile scintigraphy for right ventricle wall perfusion disorders assessment. In this group defibrillating lead was implanted to the septal position, if the perfusion disorders were in the apical segments, and to the apical position, if perfusion disorders were in the septal segment. In 2-nd group lead was implanted using conventional approach. Defibrillating lead parameters (threshold, sense, impedance and shock impedance on 1-st, 7-th, 30-th and 180-th follow-up days) were compared.

Results. The 1-st group consisted of 45 (55,5%) patients (male — 41, age 62,2±8,8 years). In 28 (62,2%) cases in this group defibrillating lead was implanted to the apical and in 17 (37,8%) — to the septal position. The 2-nd group consisted of 36 (44,5%) patients (male — 31, age 66,3±8,2 years; p=0,03). In 20 (55,5%) cases in this group defibrillating lead was implanted to the septal and in 16 (44,5%) — to the apical position. There were significant differences between groups in terms of: threshold and sense at all follow-up days (p=0,0001) and impedance on 1-st (p=0,003), 30-th (p=0,0001) and 180-th day (p=0,002), respectively.

Conclusion. Assessment of right ventricular perfusion before ICD implantation can reduce threshold and raise sense, thereby prolong the ICD longevity and improve life-threatening ventricular tachyarrhythmia detection in the early and long-term period in patients with CAD.

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