Surgical experience with defibrillator implantation using nonthoracotomy leads
| Autor: | Frank Isbruch, Michael Block, Giinter Breithardt, W. Konertz, Geiger Aw, Dieter Hammel, Hans H. Scheld, Martin Borggrefe, Boulos Asfour |
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| Rok vydání: | 1993 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Heart disease Adolescent Defibrillation medicine.medical_treatment Cardioversion Sudden cardiac death Intraoperative Period Postoperative Complications medicine Methods Humans Thoracotomy Lead (electronics) Survival rate Aged Ejection fraction business.industry Cardiac Pacing Artificial Middle Aged medicine.disease Survival Analysis Surgery Defibrillators Implantable Cardiovascular Diseases Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 55(3) |
| ISSN: | 0003-4975 |
| Popis: | Between October 10, 1989, and June 17, 1991, 109 patients with life-threatening ventricular arrhythmias received an implantable cardioverter-defibrillator at our institution. In 50 patients, nonthoracotomy lead systems consisting of a subcutaneous chest wall patch electrode near the cardiac apex and one (Cardiac Pacemakers, Inc: Endotak C) or two (Medtronic: Transvene) transvenous electrodes were tested. The mean ejection fraction was 0.44 +/- 0.15 with a range from 0.19 to 0.81. Twenty-four patients had a history of open heart operation. In 43 patients the nonthoracotomy lead system was implanted, whereas in 7 patients epicardial patch lead systems were required due to elevated defibrillation thresholds during nonthoracotomy lead testing. There was one perioperative death unrelated to the operative procedure (hydrocephalus internus). Hemorrhage from the subcutaneous patch pocket or the device pocket that required reintervention occurred in 4 patients. During a mean follow-up of 13 +/- 5 months (range, 4 to 26 months) no dislocation of an endocardial lead, insulation defect, or lead fracture has been observed. In 1 patient, the lead system had to be removed due to infection of the subcutaneous patch pocket. The cardiovascular survival rate was 98% at 12 and 18 months, and freedom from sudden cardiac death was 100% at 6 and 12 months. In conclusion, defibrillator implantation using nonthoracotomy lead systems is feasible with a success rate of 86%, and during short-term follow-up no problems related to the lead system such as dislocation, fracture, or insulation defect have occurred. |
| Databáze: | OpenAIRE |
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