title: [The implantable endocavitary cardioverter-defibrillator: the initial and short-term results].
abstract: Utilization of endocavitary defibrillation electrodes avoids thoracotomy used in implantable cardioverter-defibrillator procedures, reducing associated morbi-mortality. In our institution we have used this approach in 16 patients during a two years period (July 1990-July 1992). Fifteen were males, with a mean age of 56.9 +/- 10.6 (range 32-73). Nine patients suffered ischemic cardiomyopathy, 4 non ischemic cardiomyopathy and in three there was no structural heart disease. Mean ejection fraction was 44.3 +/- 18.3% (range 20-73%). Clinical arrhythmia was ventricular tachycardia in 8 cases, ventricular fibrillation in 6 cases and both types in 2. Endocavitary implantation procedure was not completed in 3 patients, thus an open trans-sternal approach was performed. In 13 patients it was completed successfully, using a total amount of 14 units (1 patient required two procedures due to sepsis in the generator pouch). Most important intraoperative incidences have been defibrillation thresholds between 20-24 J in 4 cases, displacement of defibrillation electrode from vena cava into coronary sinus in 4 cases, epicardial patch implantation via subcostal approach in 1 case and right ventricle perforation in 1 case. No operative mortality was registered. One patient suffered sudden death during follow-up. Surgical complications were few: 1 case of lead dislodgement and 1 infected wound in the generator's pouch. Non-surgical complications were also few: 1 case with superior vena cava syndrome and 1 patient with inadequate discharges. In conclusion, due to our early experience, we believe that endocavitary implantation of an implantable cardioverter-defibrillator is the procedure of choice at the present time.
authors.affiliation: Servicio de Cirugía Cardiovascular, Hospital Gregorio Marañón, Madrid, España.
authors.forename: C M
authors.initials: CM
authors.lastname: Merino
authors.forename: J
authors.initials: J
authors.lastname: Albertos
authors.forename: O A
authors.initials: OA
authors.lastname: Ortega
authors.forename: J M
authors.initials: JM
authors.lastname: González-Santos
authors.forename: P
authors.initials: P
authors.lastname: Garrido
authors.forename: R
authors.initials: R
authors.lastname: Fortuny
authors.forename: J F
authors.initials: JF
authors.lastname: González-de Diego
authors.forename: M J
authors.initials: MJ
authors.lastname: Rico
authors.forename: J L
authors.initials: JL
authors.lastname: Vallejo
authors.forename: R
authors.initials: R
authors.lastname: Arcas
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D004566:Electrodes; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology
vernacular_title: Cardioversor-desfibrilador implantable endocavitario: resultados iniciales y a corto plazo.