Clinical results with electrophysiologist-implanted cardioverter-defibrillators

With the advent of nonthoracotomy leads and smaller devices, implantation techniques for implantable cardioverters defibrillators (ICDs) have been simplified. We reviewed the outcome of pectoral ICD implantation by electrophysiologists in 51 consecutive patients, 47 males and 4 females, mean age 60 +/- 12 years, presenting with aborted sudden cardiac death (14) and drug refractory hypotensive ventricular tachycardia (37). Patients were implanted with either the PCD Jewel 7219D (37) or 72197C (14) Medtronic pectoral ICDs. The mean operative time was 98 +/- 31 minutes. There was no operative mortality. Complications occurred in 2 (4%) patients: right ventricular lead dislodgement requiring lead repositioning occurred in 1 patient, and 1 patient treated with anticoagulants, who had received a subcutaneous patch lead, developed a hematoma not requiring surgical reintervention. The mean defibrillation threshold was 18.6 +/- 5.5 J, but was significantly lower for the 7219C (14.1 +/- 5.0 J) compared to the 7219D (20.6 +/- 4.4 J) device, P = 0.0001. A two-lead system consisting of a right ventricular electrode (RVA) and a superior vena caval lead (SVC) was utilized in 29, RVA/SVC-subcutaneous patch in 5 and active can in 17 patients. Patients were discharged after 4.3 +/- 3 days: The procedure time was significantly shorter for the 7219C device (79.7 +/- 18.9 vs 105.2 +/- 32.8 minutes., P = 0.0035). Over the follow-up period of 8 +/- 5 (range 1-20) months, 26% patients received appropriate therapy (95% antitachycardia pacing, 5% shock). Concomitant antiarrhythmic therapy was utilized in 41% of patients. Ninety-eight percent of patients are alive. One patient died of congestive heart failure. Clinical results with electrophysiologist-implanted pectoral ICDs demonstrate low morbidity and no operative mortality in this clinical series and lower DFTs and shorter procedure times may be achieved with 7219C (active can) device.