COMPARISON OF 3 CARDIOVERTER-DEFIBRILLATOR IMPLANTATION TECHNIQUES - INITIAL RESULTS WITH TRANSVENOUS PECTORAL IMPLANTATION

A total of 121 patients underwent epicardial (n = 32), transvenous abd ominal (n = 30), and transvenous pectoral (n = 59) ICD implants. Perio perative complications were defined as those occurring within 30 days after surgery. Hospital costs were calculated with $750 per day as a f ixed charge. Duration of surgery was the time between the first skin i ncision and the last skin suture. Severe perioperative complications t hat were life-threatening or required surgical intervention occurred i n the epicardial (6%) and transvenous (10%) abdominal groups, but not in the pectoral group. Perioperative mortality occurred only in the ep icardial abdominal group, predominantly inpatients with concomitant su rgery (18%), and in 5% of patients without concomitant surgery. The du ration of surgery was significantly shorter for transvenous pectoral i mplantation (58 +/- 15 min, P < 0.05) compared to transvenous abdomina l implantation (115 +/- 38 min). Epicardial abdominal ICD implantation had the longest procedure time (154 +/- 31 min). The postimplant hosp ital length of stay was significantly shorter for pectoral implantatio n (5 +/- 3 days, P < 0.05) compared to transvenous (13 +/- 5) and epic ardial (19 +/- 5) abdominal implantation. Total hospitalization costs significantly decreased in the pectoral implantation group ($4,068 +/- $2,099 for the pectoral group vs $14,887 +/- $4,415 and $9,975 +/- $3 ,657 for the epicardial and the transvenous abdominal group, respectiv ely, P < 0.05). These initial results demonstrate the advantage of tra nsvenous pectoral ICD implantation in terms of perioperative complicat ions, procedure time, hospital length of stay, and hospitalization cos ts.