European Journal of Cardio-Thoracic Surgery, Vol 5, 315-318, Copyright © 1991 by European Association for Cardio-thoracic Surgery
Implantable cardioverter/defibrillators (ICD): a new lead-system using transvenous-subcutaneous approach in patients with prior cardiac surgery
D Hammel, M Block, T Hachenberg, M Borggrefe, T Budde, R Soeparwata, W Konertz, C Hief, HJ Geywitz and G Breithardt
Department of Thoracic and Cardiovascular Surgery, Hospital of the Westphalian Wilhelms University, Munster, FRG.
The current approach in cardioverter-defibrillator implantation requires
placement of epicardial leads which may lead to pericardial and/or pleural
effusion and pneumonia during the perioperative period. Although ICD
implantation is less invasive than other surgical techniques for the
treatment of rhythm disturbances, the perioperative mortality must be
considered. Minimizing the operative procedure could lead to a reduction in
perioperative mortality. Therefore, we investigated an approach without the
need for thoracotomy using a transvenous/subcutaneous lead system. In nine
patients with prior cardiac surgery, defibrillator implantation was
performed by a transvenous/subcutaneous approach. There was no
perioperative mortality. In all patients, a sufficient defibrillation
threshold was achieved. The defibrillation pulses were delivered as two
sequential pulses between a right ventricular electrode (cathode) and a
coronary sinus or superior caval vein electrode (anode 1) and a
subcutaneous patch electrode (anode 2). Intubation of the coronary sinus
was necessary in 4 patients in order to obtain satisfactory defibrillation
thresholds. These data demonstrate that a transvenous/subcutaneous approach
is feasible in patients with prior cardiac surgery obviating the need for
thoracotomy. Sensing function of the RV-electrode, intubation of the
coronary sinus and the intraoperative use of an epicutaneous patch
electrode are current problems of this new technique.
