Clinical results with electrophysiologist-implanted cardioverter-defibrillators

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Advancements in nonthoracotomy leads and smaller devices have simplified implantable cardioverter-defibrillator (ICD) implantation.
• Pectoral ICD implantation is increasingly performed by electrophysiologists for managing life-threatening arrhythmias.

Purpose of the Study:

• To review the outcomes of pectoral ICD implantation performed by electrophysiologists.
• To evaluate the safety, efficacy, and device-specific performance of Medtronic pectoral ICDs.

Main Methods:

• Retrospective review of 51 consecutive patients undergoing pectoral ICD implantation by electrophysiologists.
• Patients received either Medtronic PCD Jewel 7219D or 72197C devices.
• Data collected included operative time, complications, defibrillation thresholds (DFT), and follow-up outcomes.

Main Results:

• No operative mortality was observed; complication rate was 4% (lead dislodgement, hematoma).
• The Medtronic 7219C device showed significantly lower mean DFT (14.1 J) and shorter mean procedure time (79.7 min) compared to the 7219D (20.6 J, 105.2 min).
• At a mean follow-up of 8 months, 98% of patients were alive, with 26% receiving appropriate ICD therapy.

Conclusions:

• Electrophysiologist-implanted pectoral ICDs are associated with low morbidity and no operative mortality.
• The Medtronic 7219C (active can) device may offer advantages in terms of lower DFTs and shorter procedure times.
• Pectoral ICD implantation is a safe and effective strategy for patients with high risk of sudden cardiac death.