PMID- 7695926
OWN - NLM
STAT- MEDLINE
DCOM- 19950501
LR  - 20190512
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 8
IP  - 12
DP  - 1994
TI  - The implantable cardioverter defibrillator: the end of the thoracotomy approach.
PG  - 628-34
AB  - Internal cardioverter defibrillator (ICD) implantation has become a standard 
      therapy for life-threatening arrhythmias. A simple and safe surgical implantation 
      technique is therefore mandatory in this high risk population. In a 30-month 
      period 86 patients received 87 ICD devices. An endocavitary lead system was used 
      as first choice in 62 patients and defibrillation thresholds (DFT) of 25 joules 
      (J) or less were obtained in 57 patients. A thoracotomy approach was avoided 
      using a biphasic shock wave form in 17 patients and the addition of a 
      subcutaneous (sc) patch in 11 patients or wire array lead in 9 patients. There 
      was one early non-technique related death (1.7%) after the transvenous approach. 
      Reoperation was necessary in three patients with lead complications and in two 
      patients for local device problems (one migration, one infection). With the 
      recent progress in ICD technology, a thoracotomy approach could be avoided for 
      the last 52 patients. For comfort and cosmetic reasons left subcostal insertion 
      of the device has been successfully used in the last 50 patients. We conclude 
      that the nonthoracotomy approach can now be offered to all patients in need for 
      an ICD as a consequence of the technological progress made in the field of 
      electric treatment of malignant ventricular arrhythmias. A stepwise approach with 
      a minimum of implanted hardware and the use of biphasic shock systems now offers 
      a simple and efficient treatment alternative with very low perioperative risk. 
      Internal cardioverter defibrillator implantation in combination with open heart 
      procedures can easily be avoided.
FAU - Wellens, F
AU  - Wellens F
AD  - Cardiovascular Center, OLV Hospital, Aalst, Belgium.
FAU - Brugada, P
AU  - Brugada P
FAU - Guiraudon, G
AU  - Guiraudon G
FAU - De Grieck, Y
AU  - De Grieck Y
FAU - De Geest, R
AU  - De Geest R
FAU - Vanermen, H
AU  - Vanermen H
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Arrhythmias, Cardiac/pathology/*therapy
MH  - *Defibrillators, Implantable
MH  - *Electric Countershock/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Retrospective Studies
MH  - Thoracotomy
EDAT- 1994/01/01 00:00
MHDA- 1994/01/01 00:01
CRDT- 1994/01/01 00:00
PHST- 1994/01/01 00:00 [pubmed]
PHST- 1994/01/01 00:01 [medline]
PHST- 1994/01/01 00:00 [entrez]
AID - 10.1016/s1010-7940(05)80100-9 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 1994;8(12):628-34. doi: 10.1016/s1010-7940(05)80100-9.