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Alternative Lead Positioning in the Right Ventricular Outflow Tract in Transvenous Implantation of ICDs

Pacing and sensing failure in apical right ventricular coil electrode PCD implantation due to ventricular scars or aneurysma may force the implanting surgeon to switch to more invasive procedures such as subxyphoidal pericardiotomy or thoracotomy for epimyocardial corkscrew electrode and for epicardial patch application. In order to avoid this more invasive operation in the most severely impaired patients, right ventricular outflow tract positioning of the RV electrode is suggested as an alternative RV electrode site for implantation. A study of four cases shows that this occasional procedure is a practicable method to avoid more invasive techniques. Excellent pacing, sensing, and defibrillation characteristics were obtained and application is relatively simple.