THE SUBPECTORAL APPROACH - INTRAOPERATIVE DATA AND LONG-TERM OUTCOME OF PATIENTS WITH A DEFIBRILLATOR

The present study examined the perioperative mortality and morbidity a nd lead-related complications in patients who had a defibrillator with a transvenous lead system and subpectoral implantation of the generat or. Fifty-four out of 57 consecutive patients (95%) received a transve nous lead system. One patient had an acceptable defibrillation thresho ld with an additional subcutaneous patch whereas no sufficient defibri llation threshold was found in another 2 patients. Two patients died d ue to congestive heart failure after implantation. Perioperative compl ications were observed in 4 patients (7%) including pericardial effusi on, pocket hematoma, injury of the plexus brachialis and a pneumothora x. None of these complications required surgical intervention. Fifty-f ive patients were discharged from the hospital. During 27 +/- 10 month s none of these patients died. Lead-related complications were observe d in 3 patients (5,5%) including microdislocation in two and a outer c onductor fracture in one of the lead. Conclusion:Technical advancement such as a nonthoracotomy lead system and smaller devices have made th e one-incision approach and subpectoral implantation of the ICD genera tor clinical routine. Nevertheless complications related to the lead s ystem can occur. Therefore frequent controls of patients with ICD are necessary.