Video-assisted thoracoscopic implantation of cardioverter-defibrillator systems

Implantation of cardioverter-defibrillators in patients with limited venous access due to recurrent infections, thrombosis, or congenital anomalies can be challenging. For this subset of patients, we performed a video-assisted thoracoscopic intrapericardial implantation using standard shock electrodes and epicardial leads. The pulse generator was placed in pectoral or subcostal position. All pacing and sensing parameters and defibrillation thresholds were satisfactory and stable in time. No major complications were reported. Our limited experience suggests that this technique is a potential alternative in patients where endocardial implantation should be avoided.