A permanent transvenous lead system for an implantable pacemaker cardioverter-defibrillator. Nonthoracotomy approach to implantation
| Autor: | George J. Klein, Raymond Yee, Caro Norris, James W. Leitch, Douglas L. Jones, Gerard M. Guiraudon, Colette M. Guiraudon |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Adult
Male medicine.medical_specialty Pacemaker Artificial Defibrillation medicine.medical_treatment Electric Countershock Ventricular tachycardia Veins Postoperative Complications Superior vena cava Physiology (medical) Internal medicine Tachycardia medicine Humans Coronary sinus Aged Ejection fraction medicine.diagnostic_test business.industry Cardiac Pacing Artificial Prostheses and Implants Middle Aged medicine.disease Surgery Thoracotomy Evaluation Studies as Topic Ventricular fibrillation Ventricular Fibrillation Cardiology Female Implant Cardiology and Cardiovascular Medicine business Electrocardiography |
| Zdroj: | ResearcherID |
| ISSN: | 0009-7322 |
| Popis: | A transvenous lead system for implantable defibrillators would obviate a surgical thoracotomy and reduce the morbidity and mortality associated with implantation. We evaluated the clinical performance of a new nonthoracotomy lead system that included a defibrillation lead in the coronary sinus. At the time of defibrillator implantation, transvenous defibrillation leads were inserted percutaneously through the left subclavian vein into the right ventricular apex (RVA), superior vena cava (SVC), and distal coronary sinus (CS) under fluoroscopic guidance. A subcutaneous patch electrode (SQ) was also available if required. The first single- or dual-pathway electrode configuration that successfully terminated three of four ventricular fibrillation episodes using 18 J or less was implanted. Eleven men and three women aged 39-77 years (60.0 +/- 10.1 years) with left ventricular ejection fraction ranging from 16% to 63% (33.4 +/- 13.1%) were evaluated. Nine presented with ventricular tachycardia, three had ventricular fibrillation, and two had both. A totally transvenous lead system (RVA/CS/SVC) was implanted in seven patients (50%) with a mean defibrillation threshold of 15.6 +/- 2.9 J (10-18 J). Four patients received a partial transvenous lead system (RVA/CS/SQ). An effective nonthoracotomy lead system was not found in three patients; they received epicardial electrodes. After cumulative follow-up of 73 patient-months, nine patients remain alive and free of problems related to the implanted nonthoracotomy leads. One patient died of respiratory failure 3 months after defibrillator implant, and the leads from another patient were removed at 9 months because of bacterial infection. A transvenous lead system that includes a defibrillation lead in the coronary sinus is a safe, reliable, and, at least in the short term, effective nonthoracotomy approach for automatic defibrillator implantation. |
| Databáze: | OpenAIRE |
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