[Pectoral cardioverter-defibrillator implantation combined with transvenous bipolar defibrillation electrodes].
Ultimately, implantable cardioverter-defibrillators (ICD) will one day be implantable like present pacemakers. However, due to the size of the pulse generator and the low defibrillation efficacy of monophasic shocks, only a few selected patients have been implanted transvenously-pectorally. Therefore, we have prospectively investigated whether a transvenous-pectoral approach is in general feasible with a new downsized ICD capable of delivering biphasic shocks. Out of 33 patients, 76% received a bipolar transvenous defibrillation lead system. In the first 13 consecutive patients, a randomized crossover study showed that this high efficacy was above all achieved by a superior defibrillation efficacy of the biphasic waveform in comparison to the monophasic waveform (69% vs. 23%; p = 0.03). Not a single patient could be defibrillated exclusively with the monophasic waveform. In a further 15 consecutive patients, a crossover study showed that a position of the transvenous anode within the Vena anonyma instead of the Vena cava superior is, in general, not superior (87% vs. 80%; p = 0.67). Only one patient could be exclusively defibrillated with the V. anonyma position. Intraoperatively, no complications occurred and all but one patient received a pectoral implantation of the pulse generator. Postoperatively, in five patients local complications related to the ICD system were seen; two needed a surgical revision. In two patients movements of the left shoulder joint were temporarily restricted. Thus, in the majority of patients a new downsized ICD capable of biphasic shocks can be implanted transvenously-pectorally like a pacemaker.
Medizinische Klinik und Poliklinik, Westfälische Wilhelms-Universität Münster.
M
M
Block
D
D
Hammel
D
D
Böcker
M
M
Borggrefe
M
M
Castrucci
C
C
Fastenrath
H H
HH
Scheld
G
G
Breithardt
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles; D011446:Prospective Studies; D016896:Treatment Outcome; D014683:Vena Cava, Superior; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*
Pektorale Kardioverter-Defibrillator-Implantation in Kombination mit transvenösen bipolaren Defibrillationselektroden.