PubMed · 1697954
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M A Ruder, R H Mead, N A Smith, R A Winkle. 1990. Defibrillator "twiddler's" syndrome.. https://doi.org/10.1111/j.1540-8159.1990.tb02154.x
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We describe the case of a 59-year-old gentleman with severe dilated cardiomyopathy requiring implantation of a dual-chamber biventricular implantable cardioverter-defibrillator (ICD). High defibrillation thresholds (DFT) were encountered at implant with an inadequate defibrillation safety margin. Testing of all possible shock vectors/polarities with and without the SVC coil and optimization of the distal RV coil position all proved inadequate. A satisfactory defibrillation safety margin was achieved following placement of a second lead in the coronary sinus to enable biventricular defibrillation. This case highlights an additional strategy for combating high DFTs and is an option even in dual-chamber biventricular ICD systems.