Implantable Cardioverter Defibrillator Implanted by Nonthoracotomy Approach: Initial Clinical Experience with the Redesigned Transvenous Lead System

Standard implantation procedure for the implantable Cardioverter defibrillator (ICD) has traditionary required a thoracotomy approach. A newly revised nonthoracotomy defibrillator lead system that uses a single transvenous tripolar endocardial lead alone or in combination with a subcutaneous/submusc...

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Bibliographic Details
Published in:Pacing and clinical electrophysiology 1991-11, Vol.14 (11), p.1865-1869
Main Authors: MOORE, STEPHEN L., MALONEY, JAMES D., EDEL, THOMAS B., MCGUINN, WM. P., GOHN, DOUGLAS, MORANT, VICTOR A., TROHMAN, RICHARD, SIMMONS, TONY W., WILKOFF, BRUCE L., CASTLE, LON W.
Format: Article
Language:English
Subjects:
Aged
Electric Countershock - instrumentation
Electrodes, Implanted
Equipment Design
Follow-Up Studies
Humans
implantable Cardioverter defibrillator
Middle Aged
nonthoracotomy
Prostheses and Implants
Risk Factors
Tachycardia - epidemiology
Tachycardia - therapy
Thoracotomy
transvenous
Ventricular Fibrillation - epidemiology
Ventricular Fibrillation - therapy
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Summary:Standard implantation procedure for the implantable Cardioverter defibrillator (ICD) has traditionary required a thoracotomy approach. A newly revised nonthoracotomy defibrillator lead system that uses a single transvenous tripolar endocardial lead alone or in combination with a subcutaneous/submuscular patch lead was introduced into clinical trials in September, 1990. Fourteen patients requiring a Cardioverter defibrillafor for recurrent sustained ventricular tachycardia (eight patients) or aborted sudden cardiac death (six patients) were evaluated for implantation of this lead system. Primary successful lead system implantation was obtained in nine patients. The remaining five patients had unacceptably high defibrillation thresholds (DFTs) for implantation. One of the nine initially successful implants demonstrated unacceptable DFTs and cross‐talk inhibition from a permanent pacemaker necessitating removal of the nonthoracotomy lead system and replacement with a conventional lead system via thoracotomy. All remaining primary implanted patients experienced successful conversion of induced ventricular fibrillation prior to hospital discharge. Continued follow‐up and greater experience to confirm the durability and efficacy of the nonthoracotomy AICD lead system are needed.
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.1991.tb02781.x