The implantable cardioverter defibrillator:the end of the thoracotomy approach
| Autor: | De Grieck Y, Pedro Brugada, Francis Wellens, De Geest R, Vanermen H, Guiraudon G |
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| Rok vydání: | 1994 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent Heart disease Defibrillation medicine.medical_treatment Population Electric Countershock medicine Humans Thoracotomy Lead (electronics) education Aged Retrospective Studies education.field_of_study business.industry Arrhythmias Cardiac General Medicine Perioperative Middle Aged Prognosis medicine.disease Implantable cardioverter-defibrillator Defibrillators Implantable Surgery Ventricular fibrillation Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 8:628-634 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/s1010-7940(05)80100-9 |
| Popis: | Internal cardioverter defibrillator (ICD) implantation has become a standard therapy for life-threatening arrhythmias. A simple and safe surgical implantation technique is therefore mandatory in this high risk population. In a 30-month period 86 patients received 87 ICD devices. An endocavitary lead system was used as first choice in 62 patients and defibrillation thresholds (DFT) of 25 joules (J) or less were obtained in 57 patients. A thoracotomy approach was avoided using a biphasic shock wave form in 17 patients and the addition of a subcutaneous (sc) patch in 11 patients or wire array lead in 9 patients. There was one early non-technique related death (1.7%) after the transvenous approach. Reoperation was necessary in three patients with lead complications and in two patients for local device problems (one migration, one infection). With the recent progress in ICD technology, a thoracotomy approach could be avoided for the last 52 patients. For comfort and cosmetic reasons left subcostal insertion of the device has been successfully used in the last 50 patients. We conclude that the nonthoracotomy approach can now be offered to all patients in need for an ICD as a consequence of the technological progress made in the field of electric treatment of malignant ventricular arrhythmias. A stepwise approach with a minimum of implanted hardware and the use of biphasic shock systems now offers a simple and efficient treatment alternative with very low perioperative risk. Internal cardioverter defibrillator implantation in combination with open heart procedures can easily be avoided. |
| Databáze: | OpenAIRE |
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