CLINICAL-EXPERIENCE WITH THE TRANSVENOUS MEDTRONIC PACER CARDIOVERTER-DEFIBRILLATOR (PCD(R)) SYSTEM

We review our experience with the transvenous Medtronic Pacer Cardiove rter Defibrillator System (Model 7217B), a multifunction implantable p acer defibrillator combined with a transvenous lead system (Transvene( R)). From April 1991 to October 1992, we implanted this device in 19 c onsecutive patients (11 men and 8 women; average age, 56.5 years). Nin e patients (47.4%), 5 with coronary artery disease and 4 with dilated cardiomyopathy had an ejection fraction of <30%. The average operative time was 129 minutes. In 18 patients (94.7%), the transvenous lead sy stem provided effective sensing, pacing, and defibrillation during int raoperative testing. In each of these cases, the defibrillation thresh old was less than 18 J. In 1 patient (5.3%), it was necessary to switc h to epicardial leads, which were implanted through a left thoracotomy All patients were extubated in the recovery room. The average hospita l stay was 8 days. There was no early mortality or morbidity During a maximum follow-up period of 17 months (mean, 9.2 months), no sudden de ath occurred. The implantable system terminated 245 ventricular tachyc ardia episodes in 14 patients (73.7%) and 82 ventricular fibrillation episodes in 13 patients (68.4%). Two hundred eleven (86.1%) of the ven tricular tachycardia episodes were resolved by antitachycardia pacing alone. In 2 patients (10.5%), the caval electrode became dislocated; r epositioning of the electrode was followed by repeat defibrillation th reshold evaluation. Our experience shows that the transvenous Medtroni c Pacer Cardioverter Defibrillator System provides safe, effective tre atment of ventricular tachyarrhythmias. Because the perioperative mort ality and morbidity are extremely low, use of this device may be parti cularly beneficial in patients with a high operative risk. Moreover th e lower number of unpleasant therapeutic shocks should increase patien t acceptance of the device.