IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) - A NEW LEAD-SYSTEM USING TRANSVENOUS-SUBCUTANEOUS APPROACH IN PATIENTS WITH PRIOR CARDIAC-SURGERY

被引:9
作者
HAMMEL, D
BLOCK, M
HACHENBERG, T
BORGGREFE, M
BUDDE, T
SOEPARWATA, R
KONERTZ, W
HIEF, C
GEYWITZ, HJ
BREITHARDT, G
SCHELD, HH
机构
[1] Departments of Thoracic and Cardiovascular Surgery, Cardiology and Anesthesiology, Hospital of the Westphalian Wilhelms University, Munster
[2] Departments of Thoracic and Cardiovascular Surgery, Cardiology and Anesthesiology, Hospital of the Westphalian Wilhelms University, Munster
[3] Departments of Thoracic and Cardiovascular Surgery, Cardiology and Anesthesiology, Hospital of the Westphalian Wilhelms University, Munster
[4] Medtronic Bakken Research Center, Maastricht
关键词
SUDDEN CARDIAC DEATH; VENTRICULAR FIBRILLATION; INTERNAL CARDIOVERTER DEFIBRILLATOR (ICD); TRANSVENOUS SUBCUTANEOUS APPROACH;
D O I
10.1016/1010-7940(91)90042-I
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The current approach in cardioverter-defibrillator implantation requires placement of epicardial leads which may lead to pericardial and/or pleural effusion and pneumonia during the perioperative period. Although ICD implantation is less invasive than other surgical techniques for the treatment of rhythm disturbances, the perioperative mortality must be considered. Minimizing the operative procedure could lead to a reduction in perioperative mortality. Therefore, we investigated an approach without the need for thoracotomy using a transvenous/subcutaneous lead system. In nine patients with prior cardiac surgery, defibrillator implantation was performed by a transvenous/subcutaneous approach. There was no perioperative mortality. In all patients, a sufficient defibrillation threshold was achieved. The defibrillation pulses were delivered as two sequential pulses between a right ventricular electrode (cathode) and a coronary sinus or superior caval vein electrode (anode 1) and a subcutaneous patch electrode (anode 2). Intubation of the coronary sinus was necessary in 4 patients in order to obtain satisfactory defibrillation thresholds. These data demonstrate that a transvenous/subcutaneous approach is feasible in patients with prior cardiac surgery obviating the need for thoractomy. Sensing function of the RV-electrode, intubation of the coronary sinus and the intraoperative use of an epicutaneous patch electrode are current problems of this new technique.
引用
收藏
页码:315 / 318
页数:4
相关论文
共 13 条
  • [1] Bardy G.H., Allen M.D., Mehra R., Johnson G., Feldman S., Greene L., Ivey T.D., Transvenous defibrillation in humans via the coronary sinus, Circulation, 81, pp. 1252-1259, (1990)
  • [2] Borggrefe M., Podczek A., Ostermeyer J., Breithardt G., Long-term results of electrophysiologically guided antitachycardia surgery in ventricular tachyarrhythmias: A collaborative report on 665 patients, Non-Pharmacological Therapy of Tachyarrhythmias. Futura, Mount Kisco, New York, (1987)
  • [3] Brodman R., Fisher J.D., Furman S., Waspe L.E., Kim S.G., Implantation of automatic cardioverter-defibrillators via median sternotomy, Pace, 7, (1984)
  • [4] Hargrove W.C., Miller J.M., Risk stratification and management of patients with recurrent ventricular tachycardia and other malignant ventricular arrhythmias, Circulation, 79, pp. 178-181, (1989)
  • [5] Hopps J.A., Bigelow W.G., Electrical treatment of cardiac arrest: A cardiac stimulator/defibrillator, Surgery, 36, pp. 833-849, (1954)
  • [6] Kallok M., Suitability of a skin electrode for preimplant testing of sequential pulse implantable defibrillator electrode systems, Proceedings of the 20Th AAMI Meeting, (1985)
  • [7] Lawrie G.M., Griffin J.C., Wyndham C., Epicardial implantation of the automatic implantable defibrillator by left subcostal thoracotomy, Pace, 7, pp. 1370-1375, (1984)
  • [8] Mirowski M., Reid R.P., Mower M.M., Watkins L., Gott V.L., Schauble J.F., Langer A., Heilman M.S., Kolenik S.A., Fischell R.E., Weisfeldt M.L., Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings, N Engl J Med, 303, pp. 322-324, (1980)
  • [9] Moss A.J., Rivers R.J., Kramer D.H., Permanent pervenous atrial pacing from the coronary vein: Long-term follow-up, Circulation, 49, pp. 221-225, (1974)
  • [10] Troster J., Trappe H.J., Becht I., Siclari F., Klein H., Kom- plikationen bei Patienten mit implantierbarem Defibrillator, Herzschrittmacherther Und Elektrophysiol, 58, (1990)