3-YEAR OUTCOME OF A NONTHORACOTOMY APPROACH TO CARDIOVERTER-DEFIBRILLATOR IMPLANTATION IN 189 CONSECUTIVE PATIENTS

To date, no long-term clinical data have been published in patients un dergoing a nonthoracotomy approach to cardioverter-defibrillator syste m implantation. In the present report, 189 consecutive patients prospe ctively underwent a standardized approach to cardioverter-defibrillato r system implantation in which the nonthoracotomy configurations were tested first. If satisfactory defibrillation thresholds were not obtai ned, thoracotomy was performed during the same intraoperative session. A nonthoracotomy system was successfully implanted in 149 of 189 pati ents (79%), with a higher success rate (90%) observed in patients who had more recent implantations, The overall rate of complications assoc iated with these systems was low (11%). Over a mean follow up of 12.5 +/- 9.3 months, 17 patients (9%) died. Three-year total, cardiac, and sudden death-free actuarial survival for all patients was 83 +/- 11%, 88 +/- 7%, and 94 +/- 2%, respectively. Three-year sadden death-free a ctuarial survival was higher in the nonthoracotomy than in the thoraco tomy patients (97 +/- 2% vs 87 +/- 6%, p = 0.047), although total surv ival was similar (77 +/- 11% vs 83 +/- 7%, p = 0.77). These data sugge st that a majority of patients (>80%) requiring a cardioverter-defibri llator system can undergo implantation using a nonthoracotomy approach . Patients receiving nonthoracotomy systems have 3-year outcomes compa rable to those implanted via thoracotomy. If these results are maintai ned, a nonthoracotomy approach will supplant thoracotomy-implanted sys tems as the preferred method because of the simpler implant procedure and lower overall cost involved.