TRANSVENOUS IMPLANTABLE CARDIOVASCULAR DEFIBRILLATOR LEAD SYSTEM - EXPERIENCE IN 28 PATIENTS

Morbidity and mortality following Automatic Implantable Cardioverter D efibrillation (AICD) is mostly related to thoracotomy performed during placement of epicardial leads. From July 1998 to January 1994, a tran svenous lead system (TLS) (Endotak C; CPI) was implanted in 28 patient s (24 males, 4 females, age 15-76 years) who suffered from life threat ening ventricular tachyarrhythmias. Twenty four patients had a previou s MI, mean LVEF was 26% (14-65%), two had mitral valve prolapse (one w ith prolonged QT), one had hypertrophic and another had dilated cardio myopathy. The implantation procedure was performed in the operating ro om (n = 26) or in the Cath lab. (n = 2). Nineteen (out of the 28) pati ents were treated with Amiodarome before implantation (5 out of 7 had LVEF < 30%). A satisfactory defibrillation threshold (DFT) was achieve d using Endotak lead alone in 22 (79%) patients. These patients had LV EF between 10% to 65% (less than 30% in three patients). In six patien ts the DFT was measured as lower than 20 J, and a subcutaneous patch w as added(LVEF 12-38%, 4 patients with Amiodarome therapy). The implant ed devices were all from CPI: 1600 (n = 5), PRX (n = 7), P2 (n = 15), PRX II (n = 1). During a 1-32 months of follow-up one patient died fro m severe CHP. The implanted device operated in 9/28 patients. The only complication related to implantation was infection at the pocket site (n = 2), which responded to antibiotic therapy in one patient, but re quired device explantation in another patient. The device was reimplan ted in that patient three month later, with no further complications. We conclude that TLS implantation is safe and effective. Pocket infect ion is the most important complication, which can, at times, respond t o antibiotic treatment without device removal.