New approach to defibrillator insertion

The automatic implantable cardioverter/defibrillator has become an integral part of the management of patients with life-threatening ventricular rhythm disturbances. The considerable size of the device (250 gm, 10.8 by 7.6 cm) results in protrusion from the abdominal wall, with an associated alteration in self-image in all patients. In thin patients, erosion through the skin can occur. We have devised an operation in which the generator is implanted in, and becomes part of, the chest wall. The two patients in whom this approach has been used are virtually unaware of the presence of the device. We propose this operation as an alternative to abdominal wall insertion when the latter is unsuitable for technical reasons.