[Subpectoral venous approach in implantable cardioverter defibrillator systems (ICD)]

Lead complications may have fatal consequences for ICD patients. Lead fractures have been reported to occur a long time after subclavian puncture during ICD-implantation. Damage can also be caused by the patient manipulating subcutaneous lead segments. In this report we describe a simple implantation technique which avoids the risks related to subcutaneous lead position and transmuscular subclavian vein puncture. In 16 patients, after preparation of the site of the device, we chose the subpectoral venous approach for the implantation of the leads from the ICD. Available approaches are the pectoral vein, the subpectoral section of the cephalic vein or a puncture of the subclavian vein which is fully visible from that size. Once the pectoral muscle has been sutured, the entire system is protected behind it. Apart from an early postoperative lead dislocation, no complications were observed in association with the operating technique within a mean follow-up period of 10.7 +/- 6.7 (SD) months. The advantages of this technique are as follows: There is no transmuscular subclavian puncture or exposure of the deltoideopectoral groove. The entire ICD system is situated under the pectoralis major muscle. Subcutaneous lead positions with the potential complications mentioned above can thus be avoided. The fact that a more complex technique and therefore a slightly lengthier operating time is required and that this technique is not particularly suitable for local anaesthesia may be regarded as disadvantages. Due to the small number of cases and the short follow-up period, a final conclusion on the application of this technique is not possible to date.