title: Nonthoracotomy lead system for implantable defibrillator.
abstract: Over a 2-year period, 110 patients underwent attempted implantation of an automatic cardioverter-defibrillator using the nonthoracotomy lead system. Indications included sustained monomorphic ventricular (n = 62), nonsustained with poor ventricular function (n = 7), ventricular fibrillation (n = 21), ventricular tachycardia/fibrillation (n = 18), and familial long QT syndrome (n = 2). There were 90 male and 20 female patients. Mean age was 57 +/- 15 years. Sixty percent had previous coronary bypass or valve operations, or both. Mean left ventricular ejection fraction was 30% +/- 14%, cardiac index was 2.4 +/- 0.9 L/m2, and systolic pulmonary artery pressure was 41 +/- 14 mm Hg. Under general anesthesia, the nonthoracotomy lead was introduced through the left subclavian vein. The subcutaneous patch and generator were placed posteriorly on the serratus muscle and left upper quadrant, respectively. The length of the procedure was 116 +/- 44 minutes and the mean number of defibrillation shocks for a successful implant was 8 +/- 4. Eighty-five patients (77%) had successful implantations. Failures were due to high defibrillation threshold (n = 23) and inability to place a right ventricular lead (n = 2). Predictors of failure included preoperative antiarrhythmic drugs and cardiac index of 1.8 +/- 4 L/m2 or less (p = 0.004). Three patients (2.7%) died after the operation of heart failure (n = 2) and chronic heart transplant rejection (n = 1). Complications included lead migration or dislodgment (n = 8), infection (n = 1), and hematoma (n = 3). In summary, the nonthoracotomy lead system may provide an alternative in patients undergoing cardioverter-defibrillator implantation.
authors.affiliation: Loyola University Medical Center, Department of Thoracic and Cardiovascular Surgery, Maywood, Ill. 60153.
authors.forename: B P
authors.initials: BP
authors.lastname: Blakeman
authors.forename: H J
authors.initials: HJ
authors.lastname: Sullivan
authors.forename: A
authors.initials: A
authors.lastname: Montoya
authors.forename: D
authors.initials: D
authors.lastname: Calandra
authors.forename: D
authors.initials: D
authors.lastname: Wilber
authors.forename: B
authors.initials: B
authors.lastname: Olshansky
authors.forename: J
authors.initials: J
authors.lastname: Kall
authors.forename: D
authors.initials: D
authors.lastname: Kopp
authors.forename: R
authors.initials: R
authors.lastname: Pifarré
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011446:Prospective Studies; D013908:Thoracotomy; D016896:Treatment Outcome