Circulation, Vol 85, 196-204, Copyright © 1992 by American Heart Association
R Yee, GJ Klein, JW Leitch, GM Guiraudon, CM Guiraudon, DL Jones and C Norris
A transvenous lead system for implantable defibrillators would obviate a
surgical thoracotomy and reduce the morbidity and mortality associated with
implantation. We evaluated the clinical performance of a new nonthoracotomy
lead system that included a defibrillation lead in the coronary sinus. At
the time of defibrillator implantation, transvenous defibrillation leads
were inserted percutaneously through the left subclavian vein into the
right ventricular apex (RVA), superior vena cava (SVC), and distal coronary
sinus (CS) under fluoroscopic guidance. A subcutaneous patch electrode (SQ)
was also available if required. The first single- or dual-pathway electrode
configuration that successfully terminated three of four ventricular
fibrillation episodes using 18 J or less was implanted. Eleven men and
three women aged 39-77 years (60.0 +/- 10.1 years) with left ventricular
ejection fraction ranging from 16% to 63% (33.4 +/- 13.1%) were evaluated.
Nine presented with ventricular tachycardia, three had ventricular
fibrillation, and two had both. A totally transvenous lead system
(RVA/CS/SVC) was implanted in seven patients (50%) with a mean
defibrillation threshold of 15.6 +/- 2.9 J (10-18 J). Four patients
received a partial transvenous lead system (RVA/CS/SQ). An effective
nonthoracotomy lead system was not found in three patients; they received
epicardial electrodes. After cumulative follow-up of 73 patient-months,
nine patients remain alive and free of problems related to the implanted
nonthoracotomy leads. One patient died of respiratory failure 3 months
after defibrillator implant, and the leads from another patient were
removed at 9 months because of bacterial infection. A transvenous lead
system that includes a defibrillation lead in the coronary sinus is a safe,
reliable, and, at least in the short term, effective nonthoracotomy
approach for automatic defibrillator implantation.
ARTICLES
A permanent transvenous lead system for an implantable pacemaker cardioverter-defibrillator. Nonthoracotomy approach to implantation
Department of Medicine, University Hospital, London, Ontario, Canada.
This article has been cited by other articles:
 |
|
 |
|
  G. Juchem, M. Lang, K. Golczyk, M. Ulbrich, B. Reichart, and P. Lamm Successful use of transvenous coil electrodes as single element subcutaneous array leads Europace, March 1, 2009; 11(3): 391 - 394. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Goldberger and R. Lampert Implantable Cardioverter-Defibrillators: Expanding Indications and Technologies JAMA, February 15, 2006; 295(7): 809 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Paisey, A. M. Yue, F. Bessoule, P. R. Roberts, and J. M. Morgan Passive electrode effect reduces defibrillation threshold in bi-filament middle cardiac vein defibrillation. Europace, February 1, 2006; 8(2): 113 - 117. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J M Morgan The MADIT II and COMPANION studies: will they affect uptake of device treatment? Heart, March 1, 2004; 90(3): 243 - 245. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Winter, J. E. Heil, C. Schumann, Y. Lin, C. M. Schannwell, U. Michel, J. D. Schipke, H. D. Schulte, and E. Gams Effect of implantable cardioverter/defibrillator lead placement in the right ventricle on defibrillation energy requirements. A combined experimental and clinical study Eur. J. Cardiothorac. Surg., October 1, 1999; 14(4): 419 - 425. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Yamanouchi, K. A. Mowrey, M. J. Niebauer, P. J. Tchou, and B. L. Wilkoff Additional Lead Improves Defibrillation Efficacy With an Abdominal `Hot Can' Electrode System Circulation, December 16, 1997; 96(12): 4400 - 4407. [Abstract] [Full Text]
|
|
|
|
 |
|
 V. Kuhlkamp, K. Khalighi, V. Dornberger, and G. Ziemer Single-Incision and Single-Element Array Electrode to Lower the Defibrillation Threshold Ann. Thorac. Surg., October 1, 1997; 64(4): 1177 - 1179. [Abstract] [Full Text]
|
|
|
|
|
|
G. K. Jones, J. E. Poole, P. J. Kudenchuk, G. L. Dolack, G. Johnson, P. DeGroot, M. J. Gleva, M. Raitt, and G. H. Bardy A Prospective Randomized Evaluation of Implantable Cardioverter-Defibrillator Size on Unipolar Defibrillation System Efficacy Circulation, November 15, 1995; 92(10): 2940 - 2943. [Abstract] [Full Text]
|
|
|
|
|
|
P. C. Fotuhi, R. E. Ideker, S. F. Idriss, R. L. Callihan, R. G. Walker, and E. U. Alt Influence of Epicardial Patches on Defibrillation Threshold With Nonthoracotomy Lead Configurations Circulation, November 15, 1995; 92(10): 3082 - 3088. [Abstract] [Full Text]
|
|
|
|
|
|
E. U. Alt, P. C. Fotuhi, R. L. Callihan, E. Mestre, W. M. Smith, and R. E. Ideker Endocardial Carbon-Braid Electrodes : A New Concept for Lower Defibrillation Thresholds Circulation, September 15, 1995; 92(6): 1627 - 1633. [Abstract] [Full Text]
|
|
|
|
|
|
S. O. Nunain, M. Roelke, T. Trouton, S. Osswald, Y. H. Kim, G. Sosa-Suarez, D. R. Brooks, B. McGovern, M. Guy, D. F. Torchiana, et al. Limitations and Late Complications of Third-Generation Automatic Cardioverter-Defibrillators Circulation, April 15, 1995; 91(8): 2204 - 2213. [Abstract] [Full Text]
|
|
|
|
|
|
G. H. Bardy, J. E. Poole, P. J. Kudenchuk, G. L. Dolack, R. Mehra, P. DeGroot, M. H. Raitt, G. K. Jones, and G. Johnson A Prospective Randomized Comparison in Humans of Biphasic Waveform 60-µF and 120-µF Capacitance Pulses Using A Unipolar Defibrillation System Circulation, January 1, 1995; 91(1): 91 - 95. [Abstract] [Full Text]
|
|
|
|
 |
|
 A. S. Manolis Transvenous Endocardial Cardioverter Defibrillator Systems: Is the Future Here? Arch Intern Med, March 28, 1994; 154(6): 617 - 622. [Abstract] [PDF]
|
|