BACKGROUND: Preventing ventricular arrhythmias in patients with cardiac amyloidosis is challenging since the amyloid protein deposition in the myocardium may interfere with the normal cardiac electric excitation. Most of these patients succumb to either progressive congestive heart failure, or sudden cardiac death (SCD). Implantable cardioverter defibrillator (ICD) offers a near sure means of preventing SCD. HYPOTHESIS: Myocardial infiltration with amyloid results in elevated defibrillation threshold (DFT). Intra-operative strategies may fail to lower DFT during implantation. METHODS: We present a case of a 64-year-old female who had cardiac amyloidosis, and was successfully treated with an ICD and a subcutaneous array lead system. CONCLUSION: A subcutaneous array lead system is useful in reducing the DFT, and can terminate ventricular tachycardia or fibrillation by allowing more energy delivery and efficient defibrillation.
BACKGROUND: Preventing ventricular arrhythmias in patients with cardiac amyloidosis is challenging since the amyloid protein deposition in the myocardium may interfere with the normal cardiac electric excitation. Most of these patients succumb to either progressive congestive heart failure, or sudden cardiac death (SCD). Implantable cardioverter defibrillator (ICD) offers a near sure means of preventing SCD. HYPOTHESIS: Myocardial infiltration with amyloid results in elevated defibrillation threshold (DFT). Intra-operative strategies may fail to lower DFT during implantation. METHODS: We present a case of a 64-year-old female who had cardiac amyloidosis, and was successfully treated with an ICD and a subcutaneous array lead system. CONCLUSION: A subcutaneous array lead system is useful in reducing the DFT, and can terminate ventricular tachycardia or fibrillation by allowing more energy delivery and efficient defibrillation.
Authors: Srikanth Seethala; Sandeep Jain; N Paul Ohori; Sara Monaco; Joan Lacomis; Frederick Crock; Jan Nemec Journal: Indian Pacing Electrophysiol J Date: 2010-03-05
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