| Autor: |
Kelly, Patricia A., Mann, David E., Harken, Alden H., Manart, Frank D., Reiter, Michael J. |
| Předmět: |
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| Zdroj: |
Pacing & Clinical Electrophysiology; Dec1994, Vol. 17 Issue 12, p2247-2254, 8p |
| Abstrakt: |
Most current non thoracotomy systems for defibrillator implantation use monophasic devices. To determine the safety and efficacy of a new non thoracotomy lead configuration when used in conjunction with a device that used biphasic waveforms, 38 consecutive patients were taken to the operating room for implantation of a Cadence tiered therapy defibrillator system. The lead system consisted of a transvenous coil electrode positioned at the right atrial-superior vena caval junction, a bipolar endocardial right ventricular lead, and a large patch placed subcutaneously near the cardiac apex. Of the 38 non thoracotomy defibrillator implantations attempted, 36 (95%) were completed with adequate defibrillation thresholds. The mean defibriliation threshold in these 36 patients was ⩽ 563 ± 10 V (⩽ 20 ± 1 J). There was no perioperative mortality. Complications included coil lead migration (5). sensing lead migration (1), infection (3), pneumothorax (2), arterial embolism (1), and folding of the subcutaneous patch with an increase in defibriliation threshold (1). No patient died during a median follow-up period of 22 weeks. Fourteen patients (39%) had spontaneous sustained ventricular tachyarrhythmias, which were all successfully terminated by the implanted device. Shocks for nonsustained arrhythmias were aborted in eight patients (22%). Spurious discharges for sinus tachycardia or atrial fibrillation occurred in six patients (17%) and were readily diagnosed by examination of the stored electrograms. Thus, implantation of a biphasic tiered therapy defibrillator system using this non thoracotomy approach is feasible in the majority of patients. The major complication associated with this procedure is lead dislodgment. The clinical course of these patients compares favorably with that of patients who have undergone defibrillator implantation via an epicardial approach. [ABSTRACT FROM AUTHOR] |
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