title: Experience of cardioverter-defibrillators inserted without thoracotomy: evaluation of transvenously inserted intracardiac leads alone or with a subcutaneous axillary patch.
abstract: OBJECTIVE
  To compare the efficacy of a purely transvenous cardioverter-defibrillator (ICD) system with that of a system with a supplementary subcutaneous patch. To evaluate clinical follow up of these lead arrangements that do not require thoracotomy.
  
  
  METHODS
  A simplified defibrillation protocol to test two different lead arrangements during implantation, with routine clinical follow up after implantation.
  
  
  METHODS
  Tertiary referral centre for treatment of arrhythmia.
  
  
  METHODS
  22 consecutive patients selected for implantation of an ICD because of life-threatening ventricular arrhythmias (ventricular fibrillation or sustained ventricular tachycardia) of whom 20 entered the test protocol.
  
  
  METHODS
  Implantation of an ICD with transvenously inserted intracardiac leads and a subcutaneous patch and assessment of effective defibrillation followed by testing of the purely transvenous approach.
  
  
  METHODS
  Reproducible conversion of ventricular fibrillation to sinus rhythm at a certain energy level, providing a safety margin of at least 10 J for both lead arrangements. Confirmation of efficacy during clinical follow up (mean 6 months).
  
  
  RESULTS
  A transvenous lead system combined with a subcutaneous axillary patch was implanted in 20/22 patients and it provided adequate and acceptable energy levels. In 10/20 tested patients a purely transvenous lead configuration provided an acceptable safety margin as well. Nine patients had clinical recurrences: all these arrhythmias were successfully converted.
  
  
  CONCLUSIONS
  A transvenous lead system was sufficient in 50% of the patients at the time of implantation. Data on long-term clinical follow up of this arrangement are not available. The approach without thoracotomy with a subcutaneous patch is feasible and effective in most patients selected for ICD treatment.
authors.affiliation: Department of Cardiology, University Hospital, Ghent, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Jordaens
authors.forename: J W
authors.initials: JW
authors.lastname: Trouerbach
authors.forename: P
authors.initials: P
authors.lastname: Vertongen
authors.forename: L
authors.initials: L
authors.lastname: Herregods
authors.forename: J
authors.initials: J
authors.lastname: Poelaert
authors.forename: G
authors.initials: G
authors.lastname: Van Nooten
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization; D017147:Defibrillators, Implantable; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000628:therapy; D013908:Thoracotomy