title: Successful implantable cardioverter defibrillator placement in an ambulatory patient without thoracic venous access.
abstract: Evaluation of an individual requiring permanent cardiac pacing and implantable cardioverter defibrillator (ICD) function revealed no suitable thoracic vascular access for traditional device implantation. Because the patient refused cardiac surgery, a left femoral venous approach was used to introduce two extended-length, active fixation leads that were positioned in the right atrium and ventricle. The leads were tunneled to the abdomen and connected to a dual-chamber ICD. A low defibrillation threshold and robust pacing and sensing parameters were observed at implant. All of these parameters were stable at 6-month follow-up. In addition, no negative effects of the predominantly abdominal shock vector were observed. This case suggests that femoral ICD placement should be considered before routinely referring such patients for open chest surgery.
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
authors.forename: Zayd A
authors.initials: ZA
authors.lastname: Eldadah
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Donahue
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures; D001919:Bradycardia / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005268:Femoral Vein / Q000601:surgery; D006323:Heart Arrest / Q000628:therapy; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D013575:Syncope / Q000628:therapy