The Annals of Thoracic Surgery, Vol 55, 685-693, Copyright © 1993 by The Society of Thoracic Surgeons
Surgical experience with defibrillator implantation using nonthoracotomy leads
D Hammel, M Block, W Konertz, M Borggrefe, F Isbruch, B Asfour, A Geiger, G Breithardt and HH Scheld
Department of Thoracic and Cardiovascular Surgery, Hospital of Westphalian Wilhelms University of Muenster, Federal Republic of Germany.
Between October 10, 1989, and June 17, 1991, 109 patients with life-
threatening ventricular arrhythmias received an implantable
cardioverter-defibrillator at our institution. In 50 patients,
nonthoracotomy lead systems consisting of a subcutaneous chest wall patch
electrode near the cardiac apex and one (Cardiac Pacemakers, Inc: Endotak
C) or two (Medtronic: Transvene) transvenous electrodes were tested. The
mean ejection fraction was 0.44 +/- 0.15 with a range from 0.19 to 0.81.
Twenty-four patients had a history of open heart operation. In 43 patients
the nonthoracotomy lead system was implanted, whereas in 7 patients
epicardial patch lead systems were required due to elevated defibrillation
thresholds during nonthoracotomy lead testing. There was one perioperative
death unrelated to the operative procedure (hydrocephalus internus).
Hemorrhage from the subcutaneous patch pocket or the device pocket that
required reintervention occurred in 4 patients. During a mean follow-up of
13 +/- 5 months (range, 4 to 26 months) no dislocation of an endocardial
lead, insulation defect, or lead fracture has been observed. In 1 patient,
the lead system had to be removed due to infection of the subcutaneous
patch pocket. The cardiovascular survival rate was 98% at 12 and 18 months,
and freedom from sudden cardiac death was 100% at 6 and 12 months. In
conclusion, defibrillator implantation using nonthoracotomy lead systems is
feasible with a success rate of 86%, and during short-term follow-up no
problems related to the lead system such as dislocation, fracture, or
insulation defect have occurred.
