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How to get the optimal defibrillation lead parameters using myocardial perfusion scintigraphy in patients with coronary artery disease

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Abstract

The conventional criteria for a defibrillation lead (DL) implantation don’t take into account presence of scar or deep ischemia in the myocardium. This may impair a proper functioning of the DL. We sought to optimize the DL implantation placement using rest myocardial perfusion scintigraphy (MPS), which allow detecting areas of myocardial hypoperfusion (MH). To study the influence of MH and scarring, detected by MPS, on the DL parameters in patients with coronary artery disease (CAD). 69 patients (male—65, age 64.8 ± 7.7 years) with CAD and indications for ICD implantation were enrolled. Two days before ICD implantation all patients underwent MPS at rest. Then patients were divided in 2 groups. In the 1st group DL was implanted considering MPS results: to the septal position, if the most significant MH were detected in the apical segments, and to the apical position, if MH were in the septal segments. In the 2nd group DL was implanted using the conventional approach without considering MPS results. Clinical 12 months follow-up was performed with ICD interrogation. Patients of both groups were comparable by clinical and scintigraphic parameters. In the same time, in the 1st group pacing threshold was lower (p < 0.0001) and ventricle signal amplitude was higher (p < 0.0001) comparing with the 2nd group at all control points. The presence of MH detected by MPS in the area of the DL placement worsens its parameters. The results of MPS in patients with CAD can be useful for optimization of DL placement.

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Abbreviations

ICD:

Implantable cardioverter-defibrillator

ATP:

Anti-tachycardia pacing

SCD:

Sudden cardiac death

VT:

Ventricular tachycardia

VF:

Ventricular fibrillation

VSA:

Ventricular signal amplitude

DL:

Defibrillation lead

PT:

Pacing threshold

CAD:

Coronary artery disease

MI:

Myocardial infarction

MPS:

Myocardial perfusion scintigraphy

99mTc-MIBI:

99MTc-methoxy-isobutyl-isonitrile

SPECT:

Single-photon emission computed tomography

SRS:

Summed rest score

AF:

Atrial fibrillation

PI:

Pace impedance

SI:

Shock impedance

PET:

Positron emission tomography

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Authors and Affiliations

  1. Department of Surgical Arrhythmology and Cardiac Pacing, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya st., 111a, Tomsk, Russian Federation, 634012

    Tariel A. Atabekov, Roman E. Batalov, Sergey N. Krivolapov, Mikhail S. Khlynin & Sergey V. Popov

  2. Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya street, 111a, Tomsk, Russian Federation

    Svetlana I. Sazonova, Anna I. Mishkina & Konstantin V. Zavadovsky

  3. Department of Clinical and Experimental Sciences, Università Degli Studi di Brescia, via san Faustino 74b, 25122, Brescia, Italy

    Antonio Curnis

Authors
  1. Tariel A. Atabekov
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  2. Roman E. Batalov
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  3. Svetlana I. Sazonova
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  4. Sergey N. Krivolapov
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  6. Anna I. Mishkina
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  7. Konstantin V. Zavadovsky
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  8. Antonio Curnis
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Correspondence to Tariel A. Atabekov.

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Atabekov, T.A., Batalov, R.E., Sazonova, S.I. et al. How to get the optimal defibrillation lead parameters using myocardial perfusion scintigraphy in patients with coronary artery disease. Int J Cardiovasc Imaging 37, 3323–3333 (2021). https://doi.org/10.1007/s10554-021-02308-x

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  • DOI: https://doi.org/10.1007/s10554-021-02308-x

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