Comparison of subxiphoid and traditional approaches for ICD implantation.
We compared clinical and electrophysiological data in 18 patients undergoing ICD implantation via a traditional (median sternotomy or left lateral thoracotomy) with 29 patients with a subxiphoid approach. Both groups were similar in terms of age, sex, left ventricular ejection fraction, presence of coronary artery disease, and clinical indication for the device. Fifteen patients (83%) with the traditional approach had previous cardiac surgery compared with 6 patients (21%) who had a subxiphoid approach (P < 0.001). Both groups had similar patch R wave and sensing R wave measurements. Patients with the traditional approach had a lower energy for defibrillation than patients with a subxiphoid approach (13.6 +/- 6.8 J vs 17.9 +/- 4.1 J, P < 0.05). Postoperative hospital days were fewer in the subxiphoid group compared with the traditional approaches (9.8 +/- 5.3 vs 13.7 +/- 7.5 days) but the differences did not reach statistical significance, possibly due to small numbers. The subxiphoid approach appears to be a reasonable alternative approach to the traditional approach in selected patients undergoing ICD implantation.
Flaker
G
G
Department of Cardiology, University of Missouri Hospital and Clinics, Columbia 65212.
Boley
T
T
Walls
J
J
Curtis
J J
JJ
D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy / Q000379:methods; D013249:Sternum / Q000601:surgery; D017180:Tachycardia, Ventricular / Q000628:therapy*; D013908:Thoracotomy / Q000379:methods; D014693:Ventricular Fibrillation / Q000628:therapy*; D014989:Xiphoid Bone