Implantation of a cardioverter/defibrillator without thoracotomy using a triple electrode system.
This article describes the implantation of an automatic implantable cardioverter/defibrillator in a 69-year-old man with coronary artery disease and recurrent sustained ventricular tachycardia without the need for a thoracotomy/sternotomy and epicardial electrodes. The patient underwent serial electrophysiological evaluation that revealed drug-refractory ventricular tachycardia. Surgical ablation was considered and rejected due to advanced, severe, pulmonary disease. A triple electrode system using two transvenous catheter electrodes and a submuscular patch electrode in the left midaxillary line was employed. A single shock was delivered simultaneously over two spatially distinct current pathways and reproducibly defibrillated ventricular fibrillation with energies less than or equal to 10 J. The automatic implantable cardioverter/defibrillator was implanted in the anterior abdominal wall and demonstrated reproducible termination of ventricular tachycardia and ventricular fibrillation.
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Fannie E. Rippel Cardiac Electrophysiology Laboratory, Newark Beth Israel Medical Center, NJ 07112.
Parsonnet
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D000368:Aged; D002405:Catheterization, Central Venous; D004554:Electric Countershock / Q000295:instrumentation*; D004567:Electrodes, Implanted; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D012008:Recurrence; D013610:Tachycardia / Q000628:therapy*