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Implantable transvenous cardioverter-defibrillators
Circulation
|April 1, 1993
Summary
Transvenous cardioverter-defibrillators are a safe and effective option for patients with ventricular arrhythmias, offering high survival rates and efficient treatment. This minimally invasive approach reduces complications and costs compared to traditional methods.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Implantable transvenous cardioverter-defibrillators (ICDs) present a less invasive alternative to sternotomy/thoracotomy for ventricular arrhythmia management.
- This approach aims to reduce procedural morbidity and healthcare costs in patients with life-threatening ventricular arrhythmias.
Purpose of the Study:
- To prospectively evaluate the safety, efficacy, and limitations of transvenous ICDs with antitachycardia pacing.
- To assess outcomes in a consecutive cohort of 84 survivors of ventricular fibrillation (VF) and sustained ventricular tachycardia (VT).
Main Methods:
- Implantation of transvenous ICDs with defibrillation threshold (DFT) testing (< or = 20 J) using various lead configurations.
- Prospective assessment of safety, efficacy, and complications in 84 patients with VF/VT.
- Evaluation of antitachycardia pacing (ATP) success rates and device therapy for arrhythmias.
Main Results:
- Successful implantation in 95% of patients (80/84), with a mean implant DFT of 10.9 J.
- Low surgical morbidity and modest postoperative complications (e.g., lead dislodgement, pocket hematomas).
- Excellent patient survival (98% at 11 months), with 39% experiencing successful device therapy for VT/VF and 88% success with ATP for VT.
Conclusions:
- Transvenous ICD implantation is practical and feasible for most candidates.
- Low implant DFTs, manageable complications, efficient arrhythmia therapy, and excellent survival rates support this approach.
- This method significantly reduces the need for antiarrhythmic drugs post-implantation.