Pectoral implantation of single-lead implantable cardioverter-defibrillators in patients without transvenous access

With the introduction of the single-lead "Active-Can" implantable cardiover ter-defibrillators, the implantation of the internal defibrillators has bec ome a technically easy procedure. With these systems lowest defibrillation thresholds are achieved with a very low complication rate. For patients wit h thrombosis of both subclavian veins, however, a transvenous implantation technique is not possible. These patients are still equipped with epicardia l patch electrodes. This article describes an alternative technique for imp lantation of this system in such patients, eliminating the need for epicard ial patches and related complications. (C) 1999 by The Society of Thoracic Surgeons.