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Joseph S. Auteri
Valluvan Jeevanandam
Mark R. Bielefeld
Juan A. Sanchez
Henry M. Spotnitz
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Ann Thorac Surg 1991;52:1052-1057
© 1991 The Society of Thoracic Surgeons

Articles

Effect of AICD patch electrodes on the diastolic pressure-volume curve in pigs

Joseph S. Auteri, MD, Valluvan Jeevanandam, MD, Mark R. Bielefeld, MD, Juan A. Sanchez, MD, Henry M. Spotnitz, MD*

Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York USA

* Address reprint requests to Dr Spotnitz, Department of Surgery, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032.

Although the automatic implantable cardioverter defibrillator (AICD) is effective against malignant ventricular arrhythmias, the effects of AICD patches on left ventricular diastolic properties have not been defined. Accordingly, extrapericardial (group E, n = 5) or intrapericardial (group I, n = 6) AICD patches were implanted through a median sternotomy in 11 anesthetized pigs. Six weeks later, using a left thoracotomy, the hearts were arrested with hypothermic cardioplegia. A balloon catheter was inserted into the left ventricle through the aortic root, and pressure-volume curves were measured before and after sequential removal of patches and pericardium. A dense intrapericardial fibrotic reaction in group I was not present in group E. Normalized left ventricular filling volumes in group E were significantly larger at pressures of 5.1 to 10, 15.1 to 20, and 20.1 to 28 mm Hg compared with group I (p < 0.05). We conclude that intrapericardial AICD patches adversely affect left ventricular diastolic pressure-volume relations and recommend that AICD patches be placed in the extrapericardial location clinically whenever possible.




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