[Transvenous cardioverter-defibrillators: clinical experience at implantation and follow-up].
Thirty-seven patients with ventricular tachyarrhythmias refractory to antiarrhythmic drug treatment, guided by electrophysiological testing, were submitted to implantation of a cardioverter-defibrillator by the transvenous technique. Mean age was 55 +/- 14 years and the underlying heart disease was coronary heart disease in 24 patients, cardiomyopathy or other etiologies in 11 patients. In 2 patients ventricular arrhythmias were idiopathic. Left ventricular ejection fraction was < or equal to 40% in 65% of the patients. The following devices were implanted: CPI Ventak P in 2 patients, Ventak P2 in 9 patients, Ventak PRx in 9 patients, Ventak PRxII in 2 patients, Telectronics Guardian ATP III 4215 in 9 patients, Siemens Siecure in 5 patients, Medtronic Jewel PCD in 1 patient. At implantation defibrillation threshold was lower with biphasic shocks than with monophasic shocks (17.0 +/- 3.2 vs 20.9 +/- 3.8 J, p < 0.003) and the need for subcutaneous patches was lower when biphasic shocks were employed. Operative and perioperative mortality were 0% and no significant complications were observed. During the follow-up (16 +/- 11 months) 35% of the patients had appropriate shocks and 93% of the patients with antitachycardia pacing availability (n = 15) had effective antitachycardia pacing interventions. The following complications were observed: lead failure in 4 patients (3 insulation breaks and 1 elongation for stretching), late lead dislodgement in 2 patients, lead recall in 1 patient, all of which required reintervention. Inappropriate shocks occurred in 30% of the patients and were related to lead failure, supraventricular arrhythmias or alternating current interference. During the follow-up one patient died of sudden death and one was submitted to heart transplantation. In conclusion, implantation of a cardioverter-defibrillator by the transvenous technique is a procedure relatively free from complications. During the follow-up lead failure appears to be one of the most relevant complications. Antitachycardia pacing allows effective termination of ventricular tachycardias without cardioversion, with a better compliance.
Boriani
G
G
Istituto di Malattie dell'Apparato Cardiovascolare, Policlinico S Orsola-Malpighi, Università degli Studi, Bologna.
Frabetti
L
L
Capucci
A
A
Galli
R
R
Parlapiano
M
M
Biffi
M
M
Sabbatani
P
P
Spedicato
L
L
Bronzetti
G
G
Pierangeli
A
A
D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome