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Ann Thorac Surg 1993;55:685-693
© 1993 The Society of Thoracic Surgeons

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Articles

Surgical experience with defibrillator implantation using nonthoracotomy leads

Department of Thoracic and Cardiovascular Surgery and Department of Cardiology, Hospital of the Westphalian Wilhelms University of Muenster, Muenster, Federal Republic of Germany

Accepted for publication June 23, 1992.

^_* Address reprint requests to Dr Hammel, Department of Cardiovascular Surgery, Hospital of the Westphalian Wilhelms University of Muenster, W-4400 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.

This article has been cited by other articles:

				D. Hammel, M. Block, A. Geiger, D. Bocker, T. Stadlbauer, G. Breithardt, and H. H. Scheld Single-incision implantation of cardioverter defibrillators using nonthoracotomy lead systems Ann. Thorac. Surg., December 1, 1994; 58(6): 1614 - 1616. [Abstract] [PDF]

				D. Hammel, H. H. Scheld, M. Block, and G. Breithardt Nonthoracotomy defibrillator implantation: A single-center experience with 200 patients Ann. Thorac. Surg., August 1, 1994; 58(2): 321 - 327. [Abstract] [PDF]

				M. J. Mack, T. E. Acuff, and W. H. Ryan Implantable cardioverter defibrillator: The role of thoracoscopy Ann. Thorac. Surg., September 1, 1993; 56(3): 739 - 740. [Abstract] [PDF]