Epicardial and nonthoracotomy defibrillation lead systems combined with a cardioverter defibrillator

The intraoperative and long-term results were reviewed in 67 patients who underwent implantation of the Ventritex Cadence defibrillator with either epicardial patch (EPI, 25 patients) or nonthoracotomy CPI Endotak (ENDO, 42 patients) defibrillation lead systems. In the ENDO group, 35 patients (83%) had a defibrillation threshold (DFT) of < or = 20 joules and did not require a subcutaneous patch. Intraoperatively, the DFT was 13 +/- 9 joules (mean +/- SD) for EPI and 15 +/- 8 joules for ENDO (P = NS). There was no perioperative death in either group. During a mean follow-up of 12 +/- 8 months, there was no sudden death, and four patients died from congestive heart failure (3 EPI, 1 ENDO). During follow-up, 875 spontaneous arrhythmia episodes (AE) occurred in 15 of 25 EPI patients (60%), versus 652 in 28 of 42 ENDO patients (67%; P = NS). Ventricular tachycardia at a rate > or = 222 beats/min or ventricular fibrillation represented 167 AE for EPI (19%) and 182 AE for ENDO (28%), and was terminated by the first shock in 76% and 75% of attempts, respectively. Ventricular tachycardia at a rate < 222 beats/min represented a total of 1,178 AE and antitachycardia pacing was successful in 660 of 708 AE (93%) with EPI and 414 of 470 AE (88%) with ENDO lead systems (P = NS). Therefore, a nonthoracotomy approach using the Cadence V-100 is safe and effective and has clinical results that are not significantly different from epicardial defibrillation lead systems.