Substernal implantation of a subcutaneous implantable cardioverter-defibrillator in a patient with preexisting hemodialysis reliable outflow graft

9^th International Conference on Nephrology: Kidney & Therapeutics

September 29-30, 2016 Orlando, USA

Roger Carrillo

University of Miami Miller School of Medicine, USA

Posters & Accepted Abstracts: J Nephrol Ther

Abstract :

Central vein stenosis is a well-documented consequence of cardiovascular implantable electronic devices. In patients with advanced kidney disease, the need to preserve venous real estate is paramount. As such, entirely subcutaneous implantable cardioverter-defibrillators (S-ICDs), which require no venous leads, present an interesting area of development. At this time, the use of S-ICDs in renal failure patients remains controversial. We present a novel approach for implanting an S-ICD in a patient with end-stage renal disease, central venous stenosis and precordial hemodialysis graft obstructing the normal subcutaneous implant site. Implanting an S-ICD in this patient as normally indicated was presumed to carry a high risk of damage to either the lead or the pre-existing graft. The placement resulted in excellent sensing from all three vectors, showing neither T-waves nor artificial potentials. Defibrillation thresholds were tested by inducing ventricular fibrillation, and the first 70 joule shock effectively terminated the arrhythmia two times. The shock impedance was recorded as 68 ohms. There were no complications from the case and the patient was doing well at two-month follow-up.

Biography :

Email: rogercar@aol.com