Automatic implantable cardioverter defibrillator implantation without thoracotomy using an endocardial and subcutaneous patch system

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Abstract

Implantation of the cardioverter defibrillator lead system by a non thoracotomy approach is feasible, has no significant perioperative complications and is well tolerated by patients. A lead configuration with catheters in superior vena cava, right ventricular apex anda subcutaneous patch was employed. The leads were inserted through the cefalic and yugular vein. Six patients were implanted with ages ranging from 53 and 69 years (X60). The left ventricular ejection fraction varied from 17 to 36% (X 25%). The mean defibrillation threshold was 20.8 J (range 18 to 22 J). An effective nonthoracotomy lead system was found in 5 patients (85.4 %); one received an epicardial electrode. During the first months a patient had a twiddle syndrome and needed a reoperation. The variation in defibrillation technique and current pathways increases the number of patients suitable for transvenous defibrillation implantation. An effective transvenous defibrillation system could be implanted for prevention of sudden death in high risk patients specially with poor ejection fraction with a lower surgical risk.