Subpectoral implantation of ICD generators: long-term follow-up.
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 < or = 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-100 in 6 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Thakur
R K
RK
Arrhythmia Service, Thoracic and Cardiovascular Institute, Lansing, MI 48910.
Ip
J H
JH
Mehta
D
D
Jung
J Y
JY
Collar
A
A
Camunas
J
J
Gomes
J A
JA
D017147:Defibrillators, Implantable; D011211:Electric Power Supplies; D004567:Electrodes, Implanted; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000601:surgery*; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors