Implantation of a Cardioverter/ Defibrillator Without Thoracotomy Using a Triple Electrode System FREE

Sanjeev Saksena, MD; Victor Parsonnet, MD

[+] Author Affiliations

Reprint requests to the Division of Cardiology, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112 (Dr Saksena).

JAMA. 1988;259(1):69-72. doi:10.1001/jama.1988.03720010047039

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ABSTRACT

ABSTRACT | REFERENCES

This article describes the implantation of an automatic implantable cardioverter/ defibrillator in a 69-year-old man with coronary artery disease and recurrent sustained ventricular tachycardia without the need for a thoracotomy/sternotomy and epicardial electrodes. The patient underwent serial electrophysiological evaluation that revealed drug-refractory ventricular tachycardia. Surgical ablation was considered and rejected due to advanced, severe, pulmonary disease. A triple electrode system using two transvenous catheter electrodes and a submuscular patch electrode in the left midaxillary line was employed. A single shock was delivered simultaneously over two spatially distinct current pathways and reproducibly defibrillated ventricular fibrillation with energies less than or equal to 10 J. The automatic implantable cardioverter/defibrillator was implanted in the anterior abdominal wall and demonstrated reproducible termination of ventricular tachycardia and ventricular fibrillation.

(JAMA 1988;259:69-72)

REFERENCES

ABSTRACT | REFERENCES

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Marchlinski FE, Flores BT, Buxton AE, et al: The automatic implantable cardioverter-defibrillator: Efficacy, complications and device failures. Ann Intern Med 1986;;104:481-488.

Mirowski M, Mower MM, Gott VL, et al: Feasibility and effectiveness of low energy catheter defibrillation in man. Circulation 1973;;47:79-85.

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Ciccone J, Saksena S, Shah Y, et al: A prospective randomized study of the clinical efficacy and safety of transvenous cardioversion for ventricular tachycardia termination. Circulation 1985;;71:571-578.

Saksena S, Rothbart ST, Calvo RA, et al: Comparison of single and dual current pathways for transvenous cardioversion in rapid ventricular tachycardia, abstracted. PACE 1987;;10:446.

Lindsay BD, Saksena S, Rothbart ST, et al: Prospective evaluation of a sequential pacing and high energy bidirectional shock algorithm for transvenous cardioversion in patients with ventricular tachycardia. Circulation 1987;;76:601-609.

Chang MS, Inone H, Kallok MJ, et al: Double and triple sequential shocks reduce ventricular defibrillation threshold in dogs with or without myocardial infarction. J Am Coll Cardiol 1986;;8:1393-1405.

Jones DL, Klein GJ, Kallok MJ: Improved internal defibrillation with twin pulse sequential energy delivery to different lead orientations in pigs. Am J Cardiol 1985;;55:821-825.

Saksena S, Calvo RA, Pantopoulos D, et al: A prospective evaluation of single and dual current pathways. PACE 1987;;10:1130-1141.

Calvo R, Saksena S, Rothbart ST, et al: Comparison of a single and two simultaneous transvenous shocks in rapid ventricular tachycardia, abstracted. Proc X World Congr Cardiol 1986;;1:185.

Saksena S, Calvo RA, Pantopoulos D, et al: Simultaneous shocks for ventricular tachycardia cardioversion: Effect of electrode position, abstracted. Proc X World Congr Cardiol 1986;;1:482.

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