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Fully transvenous cardioverter defibrillators: rare need for subcutaneous patch with two newer-generation systems
A S Manolis1, H Rastegar, P J Wang
1Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111.
American Heart Journal
|October 1, 1994
Summary
Newer transvenous implantable cardioverter-defibrillator (ICD) systems rarely require subcutaneous patches for adequate defibrillation thresholds (DFTs). This study found transvenous leads alone achieved sufficient DFTs in most patients with ventricular arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Traditional nonthoracotomy implantable cardioverter-defibribrillators (ICDs) often required combining transvenous leads with subcutaneous patches to achieve adequate defibrillation thresholds (DFTs).
- Advancements in ICD technology have introduced newer generation transvenous lead systems for clinical investigation.
Purpose of the Study:
- To evaluate the efficacy and necessity of subcutaneous patches in conjunction with newer generation transvenous ICD systems.
- To assess defibrillation thresholds (DFTs) in patients receiving transvenous ICD systems, particularly when used without a subcutaneous patch.
Main Methods:
- Thirty-eight patients with drug-refractory malignant ventricular arrhythmias underwent implantation of newer generation transvenous ICD systems.
- Systems included CPI Endotak C (single) or Telectronics EnGuard (double) leads, implanted via the left cephalic vein and tunneled to an abdominal pocket.
- Defibrillation thresholds (DFTs) were assessed, and the need for subcutaneous patches or arrays was determined.
Main Results:
- All 38 patients (100%) achieved adequate DFTs with the transvenous lead systems, averaging 13.5 +/- 5.4 J.
- Only three patients (8%) ultimately required a subcutaneous patch or array for adequate DFTs.
- In three additional patients, patches were tested but ultimately not implanted due to sufficient DFTs with transvenous leads alone.
Conclusions:
- Newer generation transvenous ICD systems, particularly when combined with second or third-generation devices, can achieve adequate DFTs without the routine need for subcutaneous patches.
- This approach simplifies implantation and potentially reduces complications associated with subcutaneous hardware.
- Transvenous lead-alone configurations are effective for defibrillation in patients with ventricular arrhythmias.