Acute Efficacy and Chronic Follow‐Up of Patients with Non‐Thoracotomy Third Generation Implantahle Defibrillators

Abstract

Non-thoracotomy implantation of implantable cardioverter defibrillators (ICDs) has simplified the process of device insertion, promising to decrease associated procedural complications while providing sudden death protection at least equal to epicardial systems. This study presents the acute and chronic results of 110 patients who underwent attempted non-thoracotomy ICD implantation with the Medtronic Transvene lead system and PCD model 7217 or 7219. Of the 110 patients attempted, 100 (91%) had the system successfully implanted without the need for an epicardial patch. One patient died 1 week postoperatively of septic shock related to the implantation (0.9% perioperative mortality). During follow-up of 16 +/- 11 months, 45% of the patients had an event detected as ventricular tachycardia; 26% of these detections were felt clinically to be due to supraventricular rhythms. Of the remainder, 87% were successfully treated with the first VT therapy, and 98% were terminated by the final therapy; 66% of the patients had at least one episode of ventricular fibrillation, of which 5% were felt to be inappropriate detections; 85% of the appropriate episodes were successfully treated with the first VF therapy, and all were converted by the final therapy. Total mortality at 6, 12, and 24 months was 3%, 11%, and 19% respectively. Only one patient had sudden cardiac death, occurring at 13 months postimplant. Overall, the non-thoracotomy lead system for this ICD displayed infrequent implant complications and proved to be reliable at terminating arrhythmias and maintaining a low rate of sudden cardiac death in this high risk population.

Komplikationen mit Sonden bei 340 Patienten mit einem implantierbaren Kardioverter/Defibrillator

“…(4,17). Die Implantation eines Kardioverter/Defibrillators stellt aber einen invasiven Eingriff mit potentiellen Risiken fŸr den Patienten dar und erfordert besondere operative Voraussetzungen sowie eine sorgfŠltige Nachsorge.…”

Implantable Cardioverter Defibrillator Events in Patients with Asymptomatic Nonsustained Ventricular Tachycardia:

“…Multiple studies have shown that implantable cardioverter defibrillators (ICDs) reduce sudden cardiac death in high risk patients who present with sustained ventricular arrhythmias, 1–20 and the majority of these patients will receive the first defibrillator shock within the first 6 to 7 months following implantation 6 , 16 , 21,22 . Most patients presenting with sustained ventricular arrhythmias will eventually receive appropriate defibrillator shock therapy, with the cumulative incidence of appropriate therapy of 13%‐47% after 1 year, and 63%‐80% after 4 to 5 years in high risk patients 7 , 13 , 23 .…”

Akute Herzrhythmusstörungen bei Schrittmacher- und Defibrillatorpatienten

“…B. durch Lagewechsel und/oder Armbewegungen provoziert werden können (13). Probleme und Komplikationen des Elektrodensystems sind nicht selten und werden in 5-10% der Patienten beobachtet.…”