Cardioverter-defibrillator implantation in the catheterization laboratory: initial experiences in 48 patients.
The exponential increase in cardioverter-defibrillator implantations has resulted in a need for safe implantations that do not require long waiting periods. We report intraoperative and follow-up results in 48 patients with ventricular tachyarrhythmias who underwent cardioverter-defibrillator implantation in the catheterization laboratory. Twenty-six (54%) patients had their first cardioverter-defibrillator implant (group 1), and 22 (46%) patients underwent pulse-generator replacement (group 2). In all patients, cardioverter-defibrillator implant or pulse-generator replacement was performed with the patient under general anesthesia. In 25 (96%) of 26 patients in group 1, cardioverter-defibrillator implantation was possible with a mean defibrillation threshold of 13 +/- 8 J. One patient had a defibrillation threshold of > 25 J, and therefore cardioverter-defibrillator implant was not achieved. This patient underwent epicardial device implantation 1 day later. Another patient in group 1 had vessel rupture (vena subclavia) intraoperatively. During a mean follow-up of 2 +/- 1 months, two patients died from congestive heart failure 2 and 4 months after device implantation. An infection occurred in one patient in group 2, 3 months after generator replacement. In conclusion, these data show that in the majority of patients cardioverter-defibrillator implantation in the catheterization laboratory is safe and has a low complication rate and therefore can generally be recommended.
Department of Cardiology, University Hospital, Hannover, Germany.
H J
HJ
Trappe
P
P
Pfitzner
J
J
Heintze
B
B
Kielblock
P
P
Wenzlaff
H G
HG
Fieguth
S
S
Demertzis
P R
PR
Lichtlen
B
B
Panning
S
S
Piepenbrock
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004566:Electrodes; D004594:Electrophysiology; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D014693:Ventricular Fibrillation / Q000150:complications / Q000503:physiopathology / Q000628:therapy