[Implantable cardioverter/defibrillators with endocardial electrode systems: long-term stability of the...

The vast majority of cardioverter/defibrillator implantations is performed with non-thoracotomy lead systems. The temporal stability of defibrillation energy requirements is well established for epicardial defibrillation lead systems, but not for non-thoracotomy lead systems. The defibrillation energy requirements were reevaluated in 30 patients, 13 months after implantation of a cardioverter/defibrillator with a non-thoracotomy lead system. The study patients group consisted of 4 females and 26 males; mean age 60.1 +/- 10.5 years; mean left ventricular ejection fraction was 32.2 +/- 6.2%. Coronary artery disease was the underlying heart disease in 12 patients, dilated cardiomyopathy in 15 patients, and artificial valve replacement in 3 patients. There was no clinical progression in the underlying heart disease between defibrillator implantation and control measurements; left ventricular ejection fraction was unchanged (32.2 +/- 6.2 vs. 32.3 +/- 6.4%); no changes occurred regarding patients' clinical status. In 27/30 patients the defibrillation threshold at defibrillator implantation could be reconfirmed at control measurements. The mean defibrillation energy/requirements at implantation (14.4 +/- 4.8 Joules) were unchanged compared to control measurements (14.8 +/- 4.6 Joules). A temporal stability of defibrillation energy requirements could be established for the monophasic (n = 15; 18.0 +/- 4 vs. 18.1 +/- 3.4 Joules) as well as for the biphasic waveform (n = 15; 11.1 +/- 3.4 vs. 11.5 +/- 2.9 Joules). The results of intraoperative defibrillation thresholds measurements are predictive for chronic defibrillation energy requirements in patients with non-thoracotomy lead systems.