A NEW TRANSVENOUS INTERNAL CARDIOVERTER-DEFIBRILLATOR - IMPLANTATION TECHNIQUE, COMPLICATIONS, AND SHORT-TERM FOLLOW-UP

Twenty-four patients with ventricular fibrillation or sustained ventri cular tachycardia underwent implantation of a new transvenous defibril lator. All patients had a device implanted without thoracotomy. High p lacement of a shock lead in the anonymous vein and inversion of the sh ock-wave polarity allowed avoidance of placement of subcutaneous patch es, Implantation time decreased from 138 minutes for the first 12 pati ents to 82 minutes for the last 12 patients, with 4 and 11 subpectoral pockets, respectively. Three patients required a minor reintervention . No bleeding or infection occurred, One episode of pulmonary edema an d one pulmonary embolism were seen in the postoperative course, No pos toperative deaths were observed, During a mean follow-up period of 4.1 2 months, 58% of the 24 patients had symptomatic arrhythmic episodes, with shocks in 50% of the 24. Inappropriate shocks were delivered in t hree cases (atrial fibrillation and T-wave sensing), One episode was n ot terminated even with four internal shocks, One patient had ventricu lar fibrillation because of a sensing problem, By reprogramming of sen sitivity, back-up pacing, and adjustment of drug therapy these arrhyth mic complications could be prevented, Pectoral implantation of a cardi overter-defibrillator is easy and can be performed by cardiologists ex perienced in pacemaker implantation, Careful postoperative observation , reprogramming after the first spontaneous event, and prehospital dis charge induction of ventricular fibrillation will prevent arrhythmic c omplications.