(Circulation. 1995;92:59-65.)
© 1995 American Heart Association, Inc.
Articles |
Results of the International Study of the Implantable Pacemaker Cardioverter-Defibrillator
A Comparison of Epicardial and Endocardial Lead Systems
From the Department of Medicine, Indiana University School of Medicine, Krannert Institute of Cardiology, Roudebush Veterans Affairs Medical Center, Indianapolis, Ind.
Correspondence to Douglas P. Zipes, MD, Krannert Institute of Cardiology, 1111 West 10th St, Indianapolis, IN 46202-4800.
Background The purpose of the present report was to document clinical experience derived from the implantation of 2834 epicardial and endocardial cardioverter-defibrillators (ICDs) in 2807 patients who were followed for almost 1 year and to compare the results obtained with the two systems.
Methods and Results Patients in the two groups had similar
clinical characteristics. More than half of the patients had a total of
almost 50 000 spontaneous ventricular tachyarrhythmias that were
terminated with equal success (
98%) by epicardial and endocardial
ICDs. Lead dislodgement and pocket infection occurred more often with
the endocardial than with the epicardial ICD, whereas perioperative
mortality was higher with the epicardial ICD than with the endocardial
ICD. Mortality from sudden cardiac death was 1.4% in the epicardial
ICD group and 0.6% in the endocardial ICD group at 1 year
(P=.069). Overall mortality at 1 year was 12.2% and 6.9%
for the epicardial and endocardial groups, respectively
(P<.001), reflecting the higher surgical mortality for the
epicardial system.
Conclusions The endocardial ICD is as effective as the epicardial ICD but incurs lower perioperative mortality.
Key Words: defibrillation • death, sudden • mortality • pacemakers
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