Effectiveness Evaluation of ICDs Implanted in the Right Side vs. Left Side

Marcio Galindo Kiuchi, Shaojie Chen, Luis Marcelo Rodrigues Paz, Helmut Pürerfellner


Background: The implantation of ICDs left pectorally is the conventional normal practice, but pathological reasons may obly to insert the devices on the right side. The aim of our evaluation was to define the outcome of right-sided implantation (n=52) on defibrillation effectiveness in comparison to the left-sided ICD implantation (n=210).

Methods: A cohort of patients received standard therapy for primary or secondary prevention of sudden cardiac death (SCD) in patients with the structural cardiac disease, lay open to the ICD-DR implantation. The 262 individuals who had all the inclusion criteria were comprised in the assessment.

Results: The defibrillation threshold testing (DFT), at the end of implantation showed that the mean energy to revert a programmed induced sustained ventricular tachycardia/ventricular fibrillation was 33.4±6.3 J for the patients that had the ICD implanted on the right side, and 23.9±5.3 J for the ones that presented the ICD positioned on the left side, P<0.0001. However the mean and the sum of shock events recorded by ICD during 1 year of monitoring, according to the side of ICD implantation, did not show any difference.

Conclusion: Our results show that ICD implantation on the right side caused an elevated DFT in comparison to the left side insertion. This study also reported that there is no difference regarding safety and effectiveness about the amount of appropriate and inappropriate shock therapies, the mean and the sum of shock events recorded by ICD during 1 year of monitoring, according to the side of ICD implantation.


Ventricular arrhythmia; Automatic implantable cardioverter-defibrillator; Right-sided implantation; Intraoperative test.

Full Text:

443 HTML


Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al.: ESC guidelines for the diagnosis and treatment of acute and chronic heart failure2008: the task force for the diagnosis and reatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29:2388–2442. DOI: 10.1093/eurheartj/ehn309

Epstein AE, Kay GN, Plumb VJ, Voshage-Stahl L, Hull M: Elevated defibrillation threshold when right-sided venous access is used for nonthoracotomy ICD lead implantation. J Cardiovesc Electrophysiol 1995; 11:979. DOI: 10.1111/j.1540-8167.1995.tb00374.x

Natale A, Sra J, Geiger MJ, Newby K, Akhtar M, Pacifico A: Right side implant of the unipolar single lead defibrillation system. Pace 1997; 20:1910–1912. DOI: 10.1111/j.1540-8159.1997.tb03595.x

Jensen SM, Pietersen A, Chen X: Implantation of Can Implantable Defibrillators in the right pectoral region. Pace 1998; 21:476–477. DOI: 10.1111/j.1540-8159.1998.tb00078.x

Roberts PR, Allen S, Betts T, Urban JF, Whitman T, Euler DE, Kallok MJ, Morgan JM: Increased defibrillation threshold with the right-sided active pectoral can. J Intervent Cardiac Electrophysiol 2000; 2:245–249. DOI:

Fonteyne W, Rottiers H, Tavernier R: Experience with right sided implantation of transvenous active can cardioverter defibrillators. Europace 2001; 2(Suppl 1):A30. DOI: 10.1016/eupace/2.Supplement_1.A30-b

Kirk MM, Shorofski SR, Gold MR: Comparison of the effects of active left and right pectoral pulse generators on defibrillation efficacy. Am J Cardiol 2001; 88:1308–1311. DOI: 10.1016/S0002-9149(01)02096-3

Gold MR, Shih HT, Herre J, Breiter D, Zhang Y, Schwartz M: Comparison of defibrillation efficacy and survival associated with right versus left pectoral placement for implantable defibrillators. Am J Cardiol 2007; 100:243–246. DOI: 10.1016/j.amjcard.2007.02.087

Martinelli Filho M, Zimerman LI, Lorga AM, Vasconcelos JTM, Rassi A Jr. Guidelines for Implantable Electronic Cardiac Devices of the Brazilian Society of Cardiology. Arq Bras Cardiol 2007; 89: e210-e238. DOI: 10.1590/S0066-782X2007001800011

Kiuchi MG, Chen S, Pürerfellner H. Incidence of ventricular arrhythmic events in CKD patients with ICD. Int J Cardiol. 2017; 227:312-317. DOI: 10.1016/j.ijcard.2016.11.094

Friedman PA , Rasmussen MJ, Grice S, Trusty J, Glikson M, Stanton MS. Defibrillation thresholds are increased by rightsided implantation of totally transvenous implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 1999;22:1186-92. DOI: 10.1111/j.1540-8159.1999.tb00599.x

Markewitz A, Kaulhach H, Mattke S, et al. The left subclavian vein as an alternative site for implantation of the second defibrillation lead. PAGE 1995;18(Pt. I):401-405.

Epstein A, Kay G, Plumh V, et al. Elevated defibrillation threshold when right-sided venous access is used for non-thoracotomy implantable defibrillator lead implantation. J Cardiovasc Electrophysiol. 1995; 6:979-986. DOI: 10.1111/j.1540-8167.1995.tb00374.x

Atary JZ, Borleffs CJ, van der Bom JG, Trines SA, Bootsma M, Zeppenfeld K, van Erven L, Schalij MJ: Right ventricular stimulation threshold at ICD implant predicts device therapy in primary prevention patients with ischaemic heart disease. Europace 2010; 12:1581–1588. DOI: 10.1093/europace/euq266

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4

DOI: https://doi.org/10.17987/icfj.v11i0.443

Copyright (c) 2017 The Authors

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.