Hj. Trappe et al., EPICARDIAL AND NONTHORACOTOMY DEFIBRILLATION LEAD SYSTEMS COMBINED WITH A CARDIOVERTER-DEFIBRILLATOR, PACE, 18(1), 1995, pp. 127-132
The intraoperative and long-term results were reviewed in 67 patients
who underwent implantation of the Ventritex Cadence defibrillator with
either epicardial patch (EPI, 25 patients) or nonthoracotomy CPI Endo
tak (ENDO, 42 patients) defibrillation lead systems. In the ENDO group
, 35 patients (83%) had a defibrillation threshold (DFT) of less than
or equal to 20 joules and did not require a subcutaneous patch. Intrao
peratively, the DFT was 13 +/- 9 joules (mean +/- SD) for EPI and 15 /- 8 joules for ENDO (P = NS). There was no perioperative death in eit
her group. During a mean follow-up of 12 +/- 8 months, there was no su
dden death, and four patients died from congestive heart failure 13 EP
I, 1 ENDO). During follow-up, 875 spontaneous arrhythmia episodes (AE)
occurred in 15 of 25 EPI patients (60%), versus 652 in 28 of 42 ENDO
patients (67%; P = NS). Ventricular tachycardia at a rate greater than
or equal to 222 beats/min or ventricular fibrillation represented 167
AE for EPI (19%) and 182 AE for ENDO (28%), and was terminated by the
first shock in 76% and 75% of attempts, respectively. Ventricular tac
hycardia at a rate <222 beats/min represented a total of 1,178 AE and
antitachycardia pacing was successful in 660 of 708 AE (93%) with EPI
and 414 of 470 AE (88%) with ENDO lead systems (P = NS). Therefore, a
nonthoracotomy approach using the Cadence V-ZOO is safe and effective
and has clinical results that are not significantly different from epi
cardial defibrillation lead systems.