FEASIBILITY OF CONCOMITANT IMPLANTATION OF PERMANENT TRANSVENOUS PACEMAKER AND DEFIBRILLATOR SYSTEMS

In 17 patients (14 men and 3 women aged 69 +/- 10 years), a transvenou s pacemaker was implanted before (8 patients), following (7 patients), or simultaneously (2 patients) with the insertion of a transvenous de fibrillator. Indications included malignant ventricular arrhythmias an d symptomatic bradycardia in all patients. All patients had structural heart disease. All pacemakers were non-programmable bipolar, either s ingle chamber (n = 7) or dual chamber (n = 10). Eleven pacemakers were rate responsive. The Transvene system was implanted in 7 patients (Pa cer-Cardioverter-Defibrillator in 6 patients and the Cadence defibrill ator in 1). The Endotak lead system was implanted in 10 patients (Vent ak in 7 patients and the Cadence in 3). The mean defibrillation thresh old was 16 +/- 5 J. Repositioning of the pacemaker leads eliminated un dersensing of ventricular filbrillation by the defibrillator, which oc curred during asynchronous pacing in 2 patients. During a mean follow- up of 11 +/- 6 months, 2 patients died because of pump failure and 7 p atients received defibrillator therapy for ventricular arrhythmias. No significant complications were noted. Successful concomitant implanta tion of transvenous pacemakers and defibrillators was thus accomplishe d in 17 patients, which suggests that insertion of a second transvenou s device can be safely accomplished.