Epicardial electrode implantation on both right and left ventricles using local anaesthesia

Abstract

Experience with a simple method of epicardialintramural pacer lead implantation on either ventricle using local anaesthesia for long term cardiac pacing in casesof symptomatic heart block ispresented. The report concerns 40 patients with 41 implants. The follow-up period was 6-19 months. There were 3 operative deaths. One ofthe deaths was coincidental and the other 2 were attributed to bad selection. Early electrode failure due to the development of an exit block occurred in 1 case; he has done well after his right ventricular electrode was transferred to the left ventricle through the same incision using local anaesthesia. There has been no late electrode failure. Nearly all the survivors have obtained excellent results. The distinct advantages offered by this technique of epicardial pacing are discussed. The mod$cation which has been introduced in extending the scope of pacer lead implantation to the left ventricle has increased the usefulness of the technique. Left ventricular placement of the electrode assures better intramural pacing.

The pacemaker-twiddler's syndrome: Another disadvantage of abdominal implantation of pulse generators

“…Our initial enthusiasm for fixation of the pacer lead to the surrounding tissues (Guharay et al, 1974) has dwindled since our experience with the patients reported here, to the extent that this practice has been abandoned altogether. Similarly, a firm compression dressing lessens the chance of excessive fluid collection but it does not obviate the…”

“…The subject has been considered from the point of view of prevention of pulse generator infection (Codini et al, 1974). We advised against drainage in our earlier communication (Guharay et al, 1974) and then had the misfortune to encounter the complication in two of our subsequent patients. We now opt for the routine use of closed-circuit vacuum-suction drainage of the pulse generator pocket for 48-96 h postoperatively.…”

“…Therefore, it is not surprising that, in our experience, only a few of the epicardially paced patients, who constitute about 15 per cent of the entire series, had developed the complete syndrome. Certainly the observation does not imply that the epicardial mode of pacing is relatively inferior, for it has been repeatedly shown that the left ventricular myocardium is physiologically a better location for pacer lead implantation (Koltz et al, 1963;Vagnini et al, 1966;Furman and Norman, 1972;Brenner et al, 1974;Guharay et al, 1974). Nevertheless, the observation does point to risk entirely, nor does it produce collapse of the pocket on to the generator to give an optimally tight-fitting size and shape.…”

“…Addition of a few simple modifications to the technique of cardiac pacing would prevent the complication; these include implantation of the pulse generator in a plane deeper to the pectoral muscles, suspending the pulse generator from the clavicle and application of vacuum-suction drainage to the generator pocket in the initial phase of wound healing. In the presence of an optimally Jitting pulse generator pocket, PTS should be rare with subclavicular subpectoral pulse generator implantation without active patient participation.The syndrome may not be as rare a cause of pacer lead malfunction as may appear from the relative paucity of reports in the literature.MORE than 2 years have passed since we described our technique of epicardial-intramural pacer lead implantation on both right and left ventricles using local anaesthesia (Guharay et al, 1974). Patients belonging to the younger age groups and those with recurrent failures of their transvenous pulse generator units due to various causes have recently been selected for epicardial pacing.…”

“…MORE than 2 years have passed since we described our technique of epicardial-intramural pacer lead implantation on both right and left ventricles using local anaesthesia (Guharay et al, 1974). Patients belonging to the younger age groups and those with recurrent failures of their transvenous pulse generator units due to various causes have recently been selected for epicardial pacing.…”