SINGLE-INCISION IMPLANTATION OF CARDIOVERTER-DEFIBRILLATORS USING NONTHORACOTOMY LEAD SYSTEMS

This study describes the placement of a newly designed implantable car dioverter defibrillator in a subpectoral device pocket using the incis ion for venous access in 16 patients undergoing implantation of an imp lantable cardioverter defibrillator with a nonthoracotomy lead system. The endocardial lead system consisted of a right atrial/superior vena cava defibrillation spring electrode and a right ventricular bipolar sensing/defibrillation electrode, inserted by cephalic venotomy or by puncturing of the subclavian vein. As a result of intraoperative testi ng using biphasic shocks the defibrillation threshold (DFT) had to be less than 24 J, otherwise an additional subcutaneous patch electrode w as placed in the lateral chest wall near the cardiac apex through anot her incision. All patients received a nonthoracotomy lead system in co mbination with a subpectoral device placement. In 11 of 16 patients th e endocardial leads alone were sufficient (DFT, 13.4 +/- 7.0 J), 5 of 16 patients (31%) required an additional subcutaneous patch electrode to achieve proper device function (DFT, 14.6 +/- 9.0 J). The operation lasted 93 +/- 20 minutes. This was a significant (p < 0.05) lower tim e consumption than standard nonthoracotomy approach combined with abdo minal device placement (120 +/- 50 minutes). There were no postoperati ve complications. During follow-up period (average, 4 months), none of the patients reported major local symptoms, especially no device migr ation occurred. This approach, in contrast to an abdominal device plac ement, avoids another incision and subcutaneous tunneling of leads. In 11 of 16 patients defibrillator implantation by a single incision in the deltoideopectoral groove was possible.