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Ann Thorac Surg 1996;61:1042
© 1996 The Society of Thoracic Surgeons

Correspondence

Defibrillator Patch Constriction

John H. Lemmer, Jr, MD

Northwest Surgical Associates, Good Samaritan Hospital, 2226 NW Pettygrove, Portland, OR 97210

To the Editor:

The recent report by Barrington and associates [1] describes the development of pericardial constriction following placement of intrapericardial defibrillator patch electrodes. In the Invited Commentary by Dr Ferguson [2] reference is made to experimental work performed by my colleagues and me and it is stated that ``placement of the patches within the pericardium was reported to be associated with lower defibrillation thresholds.'' From this, the impression might be taken that we suggested the intrapericardial location to be advantageous. Although I am pleased to see my laboratory work referenced, I would like to respectfully point out that our result was not that which was described by Dr Ferguson.

To clarify, our canine study found defibrillation thresholds to be the same whether the patches were placed inside or outside the pericardium. As concluded in our 1991 publication [3]: ``Our data indicate that neither electrode location (intrapericardial versus extrapericardial) nor the presence of abnormally thick pericardium between the patch leads and the heart significantly influenced defibrillation energy requirements.'' Data supporting this conclusion were provided in the publication.

On the basis of this work and our clinical results, we have generally advocated extrapericardial placement when possible for patients requiring open defibrillator placement procedures. We certainly agree, however, with Drs Barrington and Ferguson that it is important to maintain a high index of suspicion regarding the etiology of symptoms that develop in a patient who has previously placed defibrillation patch electrodes.

References

  1. Barrington WW, Deligonul U, Easley AR, Windle JR. Defibrillator patch electrode constriction: an underrecognized entity. Ann Thorac Surg 1995;60:1112–6.[Abstract/Free Full Text]
  2. Ferguson TB Jr. Invited Commentary to [1]. Ann Thorac Surg 1995;60:1115–6.[Free Full Text]
  3. Lemmer JH Jr, Faber LA, Mariano DJ, Drews TA, Kienzle MG. Pericardial influence on internal defibrillation energy requirements. J Thorac Cardiovasc Surg 1991;101:839–42.[Abstract]
 

Reply

T. Bruce Ferguson, Jr, MD

Division of Cardiothoracic Surgery, Washington University School of Medicine, 3108 Queeny Tower, Barnes Hospital Plaza, St. Louis, MO 63110

To the Editor:

I appreciate the clarification by Dr Lemmer and associates regarding their 1991 publication.

That implantable cardioverter-defibrillator therapy is not an exact science is presently exemplified by the nonthoracotomy intravascular and intravascular/extrathoracic lead arrays currently used, where multiple quite disparate combinations of electrodes achieve excellent results. In light of these findings, a distinction between intrapericardial and extrapericardial patch placement seems retrospectively mundane, except as relates to the points originally addressed by Barrington and associates [1].

Reference

  1. Barrington WW, Deligonul U, Easley AR, Windle JR. Defibrillator patch electrode constriction: an underrecognized entity. Ann Thorac Surg 1995;60:1112–6.[Abstract/Free Full Text]




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