CONSISTENT SUBCUTANEOUS PREPECTORAL IMPLANTATION OF A NEW IMPLANTABLECARDIOVERTER-DEFIBRILLATOR

Objective: To describe the use of a new implantable cardioverter defib rillator (ICD) that can be placed in the prepectoral region rather tha n implanted in the abdominal wall. Design: We report the experience of placement of this new ICD in the prepectoral region in 13 patients fr om Sept. 28, 1993, through Jan. 10, 1994, at the Mayo Clinic. Material and Methods: Thirteen consecutive patients offered this new ICD under went placement of transvenous defibrillation leads, and the pulse gene rator was placed in a pocket formed in the subcutaneous, prepectoral s pace. Testing ensured a defibrillation threshold of 24 J or less. Resu lts: In all 13 patients, the pulse generator could be placed in the su bcutaneous, prepectoral space. In all except one patient, acceptable d efibrillation thresholds were achieved by using lead systems placed to tally transvenously. Only one patient required placement of a subcutan eous patch. All but two patients were dismissed from the hospital with in 3 days after the ICD implantation. Conclusion: Consistent subcutane ous, prepectoral placement of this new ICD pulse generator is possible . Because the entire procedure can be performed in the pacemaker impla ntation room, the potential exists for decreasing the duration of the hospitalization and associated costs.