title: Implantable cardioverter/defibrillators (ICD): a new lead-system using transvenous-subcutaneous approach in patients with prior cardiac surgery.
abstract: The current approach in cardioverter-defibrillator implantation requires placement of epicardial leads which may lead to pericardial and/or pleural effusion and pneumonia during the perioperative period. Although ICD implantation is less invasive than other surgical techniques for the treatment of rhythm disturbances, the perioperative mortality must be considered. Minimizing the operative procedure could lead to a reduction in perioperative mortality. Therefore, we investigated an approach without the need for thoracotomy using a transvenous/subcutaneous lead system. In nine patients with prior cardiac surgery, defibrillator implantation was performed by a transvenous/subcutaneous approach. There was no perioperative mortality. In all patients, a sufficient defibrillation threshold was achieved. The defibrillation pulses were delivered as two sequential pulses between a right ventricular electrode (cathode) and a coronary sinus or superior caval vein electrode (anode 1) and a subcutaneous patch electrode (anode 2). Intubation of the coronary sinus was necessary in 4 patients in order to obtain satisfactory defibrillation thresholds. These data demonstrate that a transvenous/subcutaneous approach is feasible in patients with prior cardiac surgery obviating the need for thoracotomy. Sensing function of the RV-electrode, intubation of the coronary sinus and the intraoperative use of an epicutaneous patch electrode are current problems of this new technique.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hospital of the Westphalian Wilhelms University, Münster, FRG.
authors.forename: D
authors.initials: D
authors.lastname: Hammel
authors.forename: M
authors.initials: M
authors.lastname: Block
authors.forename: T
authors.initials: T
authors.lastname: Hachenberg
authors.forename: M
authors.initials: M
authors.lastname: Borggrefe
authors.forename: T
authors.initials: T
authors.lastname: Budde
authors.forename: R
authors.initials: R
authors.lastname: Soeparwata
authors.forename: W
authors.initials: W
authors.lastname: Konertz
authors.forename: C
authors.initials: C
authors.lastname: Hief
authors.forename: H J
authors.initials: HJ
authors.lastname: Geywitz
authors.forename: G
authors.initials: G
authors.lastname: Breithardt
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality; D003645:Death, Sudden / Q000209:etiology; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014693:Ventricular Fibrillation / Q000628:therapy*