Subpectoral Implantation of ICD Generators: Long-Term Follow-Up

• Published in: Pacing and clinical electrophysiology 1995-01, Vol.18 (1), p.159-162
• Main Authors: THAKUR, RANJAN K., IP, JOHN H., MEHTA, DAVENDRA, JUNG, JIA Y., COLLAR, ALONSO, CAMUNAS, JORGE, GOMES, J. ANTHONY
• Format: Article
• Language: English
• Subjects: defibrillation; Defibrillators, Implantable; Electric Power Supplies; Electrodes, Implanted; Equipment Design; Female; Follow-Up Studies; Heart Arrest - epidemiology; Heart Arrest - therapy; Humans; implantable defibrillator; Male; Middle Aged; Pectoralis Muscles - surgery; sudden death; Tachycardia, Ventricular - epidemiology; Tachycardia, Ventricular - therapy; Time Factors; ventricular fibrillation; ventricular tachycardia
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.1995.tb02496.x

A nonthoracotomy surgical approach using an endocardial electrode and combined implantation of a subcutaneous patch and the implantable cardioverter defibrillator (ICD) generator in a Subpectoral pocket has been described. We report the long‐term follow‐up results in patients undergoing implantation using this approach. The patient population consisted of 28 patients (22 men and 6 women) with a mean age of 59 ± 12 years. The underlying heart disease consisted of coronary artery disease in 20 patients and dilated cardiomyopathy in 8 patients. Sustained ventricular tachycardia was the mode of presentation in 16 patients and sudden cardiac death in 12 patients. The mean left ventricular ejection fraction was 31%± 6%. The lead system consisted of an 8 French bipolar passive fixation rate sensing lead positioned at the right ventricular apex, an 11 French spring coil electrode positioned at the superior vena cava‐right atrial junction (surface area 700 mm2), and submuscular placement of a large patch (surface area 28 cm2) on the anterolateral chest wall near the cardiac apex via a submammary incision. A defibrillation threshold of ≤ 15 joules (J) was required for implantation. This criterion was not satisfied in five patients; thus, a limited thoracotomy was performed via the submammary incision, and the large patch was placed epicardially. The mean R wave amplitude was 12 ± 3 mV, the mean pacing threshold was 1.0 ± 0.5 V at 0.5 msec, and the mean defibrillation threshold was 12.6 ± 3 J. ICD generators implanted were the Ventak‐P in 17, PCD‐7217 in 5, and the Cadence V‐l00 in 6 patients. These patients have been followed for a mean of 14.6 ± 6 months. There was no perioperative mortality, and none of the patients developed an infection during follow‐up. Generator migration or significant discomfort requiring ICD repositioning was not observed, although one patient developed an erosion requiring surgical repair.Conclusions: Subpectoral implantation of the ICD generator is feasible and was well tolerated by all patients with an acceptable complication rate (3.5%). As the size of future generation ICDs is reduced, subpectoral implantation may become the preferred approach.