Implantable Cardioverter Defibrillators: 6 Years Clinical Experience

Internal cardioverter defibrillator (ICD) implantation has became a standard therapy for lifethreatening arrhythmias. From October 1990 to April 1996 187 patients received 249 ICD systems in our department. The mean age was 57±21 (range 13-89 years). In the earlier years only epicardial patches were available and thoracotomy was the standard approach in 21 patients, after this period endocardial leads and subcutaneous patches were clinically available and the transvenous approach was the first choice. Acute complications were non-lethal pulmonary complications (11.1 % after thoracotomy, 0.5 % aftcr transvenous approach), sternal bleeding (1 patient), subcostal pocket hematoma ( 1 patient). Late complications were three endocardial lead failure, one pocket hematoma, one mediastinitis. From January 1992 biphasic shock wave system and SC wire array leads were clinically available. The mean monophasic defibrillation threshold was 20.3±6.2 Joules and the mean biphasic shock threshold was 14.6±3.1 (p=0.03). Results after a follow-up of 24± 18 months; patients who experienced appropriate shocks were 46 %. This study demonstrates that thoracotomy lead systems can be implanted with a high success rate and with an acceptable incidence of complications.