A Novel Approach to Extending DF-4 AICD Leads using A DF-4 Y Splitter/Adaptor as Preparation for Stereotactic Radiosurgery to The Chest - A Case Report

This is an 80-year-old Hispanic male, former smoker with 30+ pack-years, COPD, ischemic cardiomyopathy with reduced Left Ventricular Ejection Fraction (LVEF) of 15-20% refractory to an appropriate trial of optimal medical therapy, requiring upgrade to Biventricular Implantable Cardioverter-Defibrillator (BIV-ICD) implantation. Five months after BIV-ICD implantation, the LVEF had improved to 55%. During routine lung cancer screening a left upper lobe mass measuring 1.5x1.1 cm was found. A biopsy was done, and further histology showed a spiculated squamous cell carcinoma. Given his frail clinical condition it was decided that he was to receive radiotherapy only, for which the AICD generator had to be relocated away from the radiation target. To extend the DF-4 ICD lead, we used a specialized 27-cm-long DF-4 Y splitter/adaptor (Medtronic Model 5019 HV Splitter/Adaptor) which allowed enough length to extend the DF-4 ICD lead from upper chest to Left Upper Quadrant (LUQ) of the abdomen. The procedure was tolerated well by the patient, after which he made a satisfactory recovery with no postoperative complications. The patient then, in due course, underwent radiotherapy for his lung cancer. Our technique of using a DF-4 Y Splitter/Adaptor as a DF4 lead extender could be used in any patient needing an extender, such as those in which the leads had to be tunneled to the contralateral side, and not only for patients requiring radiotherapy.