The Use of Endocavitary Electrode System During Implantible Cardioverter Defibrillator Implantation

Implantibe cardioverter defibrillators (ICD) are assuming a progressively more important role in the management of drug-refractory ventricular arrhythmias. Sixty patients received an ICD at the D.L.V. Hospital in Aalst, Belgium, between October 1990 and January 1993. The mean age was 44.4 years. The patients were evaluated in three groups. Group I consists of 21 patients in which median sternotomy with double patch combination was used. In the other two groups, an endocavitary electrode system (ES) was used as first choice. In group II (22 patients) it was possible to use the ES alone in 11 patients, six patients required a subcutaneous patch and 5 patients required median sternotomy because of high defibrillation thesholds (DFT). In group III (17 patients), 16 patients received the ES. For 9 patients a subcutaneous patch had to be added to the system for high DFT (56 %). Stermotomy was used only for one patient requiring a coronary bypass operation in addition to ICD. Operative mortality did not exist. The overall mortality (early+late) was 6.6 %. We concluded that it was possible to avoid median sternotomy in 82 % of the patients.