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Ann Thorac Surg 1989;47:780-781
© 1989 The Society of Thoracic Surgeons

Articles

Right mini-thoracotomy: An adjunct to left subcostal automatic implantable cardioverter defibrillator implantation

Gerald M. Lawrie, MD*, Raj R. Kaushik, MD, Antonio Pacifico, MD

Cora and Webb Mading Department of Surgery and Medicine (Cardiology), Baylor College of Medicine, and The Methodist Hospital, Houston, Texas, USA

Accepted for publication November 18, 1988.

* Address reprint requests to Dr Lawrie, Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.

High defibrillation thresholds are encountered in some patients during implantation of the automatic implantable cardioverter defibrillator (AICD). In a consecutive series of 52 patients with AICD implants, 46 had allepicardial implants by left subcostal thoracotomy, and 8 of these patients had thresholds greater than 30 J. Placement of an apicolateral large left ventricular patch and an extrapericardial large right atrial patch electrode through a limited right thoracotomy produced substantial reduction in their thresholds. Especially in patients who have had previous intrapericardial operations, this technique provides a simple solution to the problem of high thresholds.




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