A simplified method for implantation of automatic cardioverter defibrillator in patients with previous cardiac surgery

A method of extrapericardial automatic cardioverter defibrillator implantation using bilateral limited anterior thoracotomy approach is described. The approach was used in six patients who have had previous open heart surgery. The defibrillation threshold was 15 joules in four patients and 20 joules in two. One patient died of pulmonary embolism in the tenth postoperative day. All patients were extubated within 0-18 hours. Drainage of a recurrent pleural effusion was required in one patient. This approach was found to be simple, safe, and effective in patients with previous median sternotomy. It may also be useful in patients in whom a cardiac operation may be indicated later in the course of their disease.