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[Results and experiences of transvenous endocardial defibrillator therapy]
H J Trappe1, H G Fieguth, O Weber-Conrad
1Abteilung Kardiologie, Medizinischen Hochschule Hannover.
Insights
The transvenous defibrillation lead system (ELS) is effective for patients with drug-refractory ventricular tachycardia (VT) or fibrillation (VF). This implantable cardioverter-defibrillator approach shows a low complication rate, making it a preferred method for defibrillator implantation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Context:
- 72 patients with refractory ventricular tachycardia (VT) or fibrillation (VF) were studied.
- 51 patients had coronary disease, and 21 had non-ischemic VT/VF.
- The transvenous defibrillation lead system (ELS) was evaluated for efficacy and safety.
Purpose:
- To assess the follow-up outcomes of patients receiving the Endotak transvenous defibrillation lead system (ELS).
- To determine the suitability of ELS as a primary approach for cardioverter-defibrillator implantation.
- To report intraoperative and perioperative complication rates associated with ELS implantation.
Summary:
- The study followed 72 patients implanted with the Endotak ELS for drug-refractory VT/VF.
- Mean defibrillation threshold (DFT) was 14 J for VT and 17 J for VF.
- Low complication rates (4%) including lead dislocation and pneumothorax were observed.
Impact:
- The ELS is deemed suitable for most VT/VF patients and a first-choice approach for cardioverter-defibrillator implantation.
- The study highlights the need for cardiac surgery support during ELS implantation.
- Findings support the ELS as a valuable tool in managing life-threatening ventricular arrhythmias.
Abstract:
We studied the follow-up of 72 patients who underwent implantation of a transvenous defibrillation lead system (ELS) (Endotak, CPI). All patients had ventricular tachycardia (VT) or fibrillation (VF) refractory to antiarrhythmic drug therapy. There were 51 patients with coronary disease and 21 patients had non-ischemic VT/VF. ELS was combined with a subcutaneous patch in 52 patients and implanted alone ("single lead only") in 20 patients. 40 patients received the ELS combined with antitachycardia pacing devices (Ventak PRx, CPI; Cadence, Ventritex) and 32 patients with the Ventak P 1600 or P2, CPI. Implantation of the ELS was attempted in 80 patients and performed in 72 patients (90%): Intraoperatively, the mean defibrillation threshold (DTF) was > 25 Joule (J) in five patients and no reliable ELS position was possible to achieve in three patients. These eight patients underwent thoracotomy with epicardial patch implantation. The mean DFT was < or = 20 J in all 72 patients with a mean DFT of 14 +/- 8 J in VT patients and 17 +/- 10 J in VF patients. Two of 80 patients (3%) died: one patient died intraoperatively and one during the mean follow-up of 6 +/- 2 (< 1 to 18) months. Complications occurred in three patients (4%): Dislocation of the Endotak electrode was observed in two patients (3%) and one patient developed pneumothorax postoperatively. Our data show that the ELS is most suitable in the majority of patients with VT/VF and is the approach of first choice for cardioverter defibrillator implantation at the present time. However, despite a relatively low intra- and perioperative complication rate, this approach should not be performed in institutions without cardiac surgery.