[Clinical experiences with pectoral defibrillator implantation]

The pectoral approach to implantation of cardioverter/defibrillators has the aim to further simplify the implantation of transvenous defibrillation systems. The PCD 7219 D/C is a device of the fourth generation which makes the pectoral implantation feasible due to a weight of 132 g, a size of 89 x 64 x 18 mm, a volume of 83 cm3 and a surface of 108 cm2. The use of the "active-can"-system (PCD 7219 C) requires the implantation of only one right ventricular lead. The PCD 7219 D/C was implanted in 75 patients with ventricular tachyarrhythmias, the follow-up period was 12 +/- 4 (1-24) months. Subpectoral implantation was feasible in 59 patients (79%), in 55 with a left pectoral, in 4 with a right pectoral approach due to previous left-sided operation or thrombosis of the left subclavian vein. Male sex (p < 0.005), body weight (p < 0.005) and body surface (p < 0.05) were predictors of pectoral implantation. In the 45 patients (60%) with a unipolar defibrillation system ("active can") the defibrillation threshold was significantly lower compared to those with a dual lead system (9.9 +/- 6.5, 2.5-24 Joule vs. 19 +/- 4.5, 6-24 Joule p < 0.0001). In one patient with pectoral and in one patient with abdominal implantation a dislodgement of the right ventricular lead was diagnosed and an operative revision was indicated.

The down-sized implantable cardioverter/defibrillator PCD 7219 D/C makes the pectoral implantation feasible in the majority of patients. The use of the "active-can"-system requires the implantation of only one right ventricular lead with significantly lower defibrillation thresholds.