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

Articles

Surgical experience with defibrillator implantation using nonthoracotomy leads

Dieter Hammel, MD*, Michael Block, MD, Wolfgang Konertz, MD, Martin Borggrefe, MD, Frank Isbruch, MD, Boulos Asfour, MD, Armin Geiger, MD, Günter Breithardt, MD, Hans H. Scheld, MD

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.


   Abstract
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 Abstract
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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.


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 Abstract
 References
 

  1. Echt DS, Armstrong K, Schmidt P, Oyer PE, Stinson EB, Winkle RA. Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter-defibrillator Circulation 1985;71:289-296.[Abstract/Free Full Text]
  2. Barbola J, Denes P, Ezri M, Hauser RG, Serry C, Golding, MD. The automatic implantable cardioverter defibrillator: clinical experience, complications and follow-up in 25 patients Arch Intern Med 1988;148:70-76.[Medline]
  3. Tchou PJ, Kadri N, Anderson J, Caceres JA, Jazayeri M, Ahktar M. Automatic implantable cardioverter defibrillators and survival of patients with left ventricular dysfunction and malignant ventricular arrhythmias Ann Intern Med 1988;109:529-534.[Medline]
  4. Mercando AD, Furman S, Johnston D, et al. Survival of patients with the automatic implantable cardioverter defibrillator PACE 1988;11:2059-2063.[Medline]
  5. Kelly PA, Cannom DS, Garan H, et al. The automatic implantable cardioverter defibrillator: efficacy, complications and survival in patients with malignant ventricular arrhythmias J Am Coll Cardiol 1988;11:1278-1286.[Medline]
  6. Winkle RA, Mead RH, Ruder MA, et al. Long term outcome with the automatic implantable cardioverter-defibrillator J Am Coll Cardiol 1989;13:1353-1361.[Medline]
  7. Marchena E, Chakko S, Fernandez P, et al. Usefulness of the automatic implantable cardioverter defibrillator in improving survival of patients with severely depressed left ventricular function associated with coronary artery disease Am J Cardiol 1991;67:812-816.[Medline]
  8. Liberthson RR, Nagel EL, Hirshman JC, Nussenfeld SR. Pre-hospital ventricular fibrillation: prognosis and follow-up course N Engl J Med 1974;291:317-321.[Medline]
  9. Schaffer WA, Cobb LA. Recurrent ventricular fibrillation and modes of death in survivors of out-of-hospital ventricular fibrillation N Engl J Med 1975;293:259-262.[Medline]
  10. Lehman MH, Steinman RT, Schuger CD, Jackson K. The automatic implantable cardioverter defibrillator as antiarrhythmic treatment modality of choice for survivors of cardiac arrest unrelated to acute myocardial infarction Am J Cardiol 1988;62:803-805.[Medline]
  11. Troup PJ, Chapman PD, Wetherbee JN, Almassi GH, Olinger GN. Clinical features of AICD system infections [Abstract] J Am Coll Cardiol 1988;78:155(Suppl).
  12. Almassi GH, Chapman PD, Troup PJ, Wetherbee JN, Olinger GN. Constrictive pericarditis associated with patch electrodes of the automatic implantable cardioverter defibrillator Chest 1987;92:369-371.[Medline]
  13. Hopps JA, Bigelow WG. Electrical treatment of cardiac arrest: a cardiac stimulator/defibrillator Surgery 1954;36:833-849.[Medline]
  14. Mirowski M, Mower MM, Gott VL, Brawley RK. Feasibility and effectiveness of low energy catheter defibrillation in man Circulation 1973;47:79-85.[Abstract/Free Full Text]
  15. Bach Jr SM, Barstad J, Harper N, et al. Initial clinical experience: EndotakTM—implantable transvenous defibrillator system [Abstract] J Am Coll Cardiol 1989;13:65A.
  16. Epstein AE. Transvenous defibrillation: overview of clinical results AICD Adv 1990;1:12-13.
  17. Saksena S, Parsonnet V. Implantation of a cardioverter/defibrillator without thoracotomy using a triple electrode system JAMA 1988;259:69-72.[Medline]
  18. Bardy GH, Allen, MD, Mehra R, et al. Transvenous defibrillation in humans via the coronary sinus Circulation 1990;81:1252-1259.[Abstract/Free Full Text]
  19. Hammel D, Block M, Hachenberg T, et al. Implantable cardioverter/defibrillators (ICD): a new lead-system using transvenous-subcutaneous approach in patients with prior cardiac surgery Eur J Cardiothorac Surg 1991;5:315-318.[Abstract/Free Full Text]
  20. Block M, Hammel D, Borggrefe M, et al. Erste klinische Erfahrungen mit einem transvenös-subcutanen Defibrillatorsystem Z Kardiol 1991;80:657-664.[Medline]
  21. Winkle RA. The implantable defibrillator: progression from first- to third-generation devicesIn: Zipes DP, Jalife J, editors. Cardiac electrophysiology from cell to bedside. Philadelphia: Saunders; 1990. pp. 963-969.
  22. Hammel D, Hachenberg T, Block M, et al. Implantable cardioverter/defibrillators (ICD): subxiphoidal approach versus median sternotomy Z Herz Thorax Gefäβchir 1990;4:215-219.
  23. Guarnieri T, Levine JH, Veltri EP, et al. Success of chronic defibrillation and the role of antiarrhythmic drugs with the automatic implantable cardioverter/defibrillator Am J Cardiol 1987;60:1061-1064.[Medline]
  24. Robinson LA. Effect of AICD patch electrodes on the diastolic pressure-volume curve in pigsDiscussion of Auteri JS, Jeevanandam V, Bielefeld MR, Sanchez JA, Spotnitz HM Ann Thorac Surg 1991;52:105-107.
  25. Marchlinski FE, Flores BT, Buxton AE, et al. The automatic implantable cardioverter-defibrillator: efficacy, complications and device failures Ann Intern Med 1986;104:481-488.[Medline]
  26. Tullo NG, Saksena S, Krol RB, Mauro AM, Kunecz D. Management of complications associated with a firstgeneration endocardial defibrillation lead system for implantable cardioverter-defibrillators Am J Cardiol 1990;66:411-415.[Medline]
  27. Brenner AS, Wagner GS, Anderson ST, Rosati RA, Morris JJ. Transvenous, transmediastinal, and transthoracic ventricular pacing: a comparison after complete two-year follow-up Circulation 1974;49:407-414.[Abstract/Free Full Text]
  28. Magilligan JD, Hakimi M, Davila JC. The sutureless electrode: comparison with transvenous and sutured epicardial electrode placement for permanent pacing Ann Thorac Surg 1976;22:80-86.[Abstract/Free Full Text]



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