NONTHORACOTOMY LEAD SYSTEM FOR IMPLANTABLE DEFIBRILLATOR

Over a 2-year period, 110 patients underwent attempted, implantation o f an automatic cardioverter-defibrillator using the nonthoracotomy lea d system. Indications included sustained monomorphic ventricular (n = 62), nonsustained with poor ventricular function (n = 7), ventricular fibrillation (n = 21), ventricular tachycardia/fibrillation (n = 18), and familial long QT syndrome (n = 2). There were 90 male and 20 femal e patients. Mean age was 57 +/- 15 years. Sixty percent had previous c oronary bypass or valve operations, or both. Mean left ventricular eje ction fraction was 30% +/- 14%, cardiac index was 2.4 +/- 0.9 L/M2, an d systolic pulmonary artery pressure was 41 +/- 14 mm Hg. Under genera l anesthesia, the nonthoracotomy lead was introduced through the left subclavian vein. The subcutaneous patch and generator were placed post eriorly on the serratus muscle and left upper quadrant, respectively. The length of the procedure was 116 +/- 44 minutes and the mean number of defibrillation shocks for a successful implant was 8 +/- 4. Eighty -five patients (77%) had successful implantations. Failures were due t o high defibrillation threshold (n = 23) and inability to place a righ t ventricular lead (n = 2). Predictors of failure included preoperativ e antiarrhythmic drugs and cardiac index of 1.8 +/- 4 L/M2 or less (p = 0.004). Three patients (2.7%) died after the operation of heart fail ure (n = 2) and chronic heart transplant rejection (n = 1). Complicati ons included lead migration or dislodgment (n = 8), infection (n = l), and hematoma (n = 3). In summary, the nonthoracotomy lead system may provide an alternative in patients undergoing cardioverter-defibrillat or implantation.