ACUTE EFFICACY AND CHRONIC FOLLOW-UP OF PATIENTS WITH NON-THORACOTOMY3RD GENERATION IMPLANTABLE DEFIBRILLATORS

Non-thoracotomy implantation of implantable cardioverter defibrillator s (ICDs) has simplified the process of device insertion, promising to decrease associated procedural complications while providing sudden de ath protection at least equal to epicardial systems. This study presen ts the acute and chronic results of 110 patients who underwent attempt ed non-thoracotomy ICD implantation with the Medtronic Transvene lead system and PCD model 7217 or 7219. Of the 110 patients attempted, 100 (91%) had the system successfully implanted without the need for an ep icardial patch. One patient died 1 week postoperatively of septic shoc k related to the implantation (0.9% perioperative mortality). During f ollow-up of 16 +/- 11 months, 45% of the patients had an event detecte d as ventricular tachycardia; 26% of these detections were felt clinic ally to be due to supraventricular rhythms. Of the remainder, 87% were successfully treated with the first VT therapy, and 98% were terminat ed by the final therapy; 66% of the patients had at least one episode of ventricular fibrillation, of which 5% were felt to be inappropriate detections; 85% of the appropriate episodes were successfully treated with the first VF therapy, and all were converted by the final therap y. Total mortality at 6, 12, and 24 months was 3%, 11%, and 19% respec tively. Only one patient had sudden cardiac death, occurring at 13 mon ths postimplant. Overall, the non-thoracotomy lead system for this ICD displayed infrequent implant complications and proved to be reliable at terminating arrhythmias and maintaining a low rate of sudden cardia c death in this high risk population.