Coronary sinus shocking lead as salvage in patients with advanced CHF and high defibrillation thresholds

Background: We report a series of three patients whose implantable cardioverter-defibrillators (ICD) implants were unsuccessful due to inability to achieve defibrillation thresholds (DFT) at maximum available energy after failure of standard modification and enhancement procedures. All patients had advanced cardiomyopathy. Methods: Use of the coronary sinus (CS) for left ventricular (LV) shocking electrode placement resulted in acceptable DFTs in each patient. The position of the shocking coil in all three patients was posterior, and in two patients alongside a left ventricular CS pacing lead. The best shocking configuration tested was LV (CS) + CAN (Anode) to RV (cathode) in each patient. The short- and long-term outcomes of these patients is presented and discussed. Conclusion: This approach is suggested as a salvage option for those problematic patients who have unacceptable DFT results at implantation of an endovascular ICD system.