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Experience of cardioverter-defibrillators inserted without thoracotomy: evaluation of transvenously inserted intracardiac leads alone or with a subcutaneous axillary patch

(1993) BRITISH HEART JOURNAL. 69(1). p.14-19
Author
Organization
Abstract
Objectives: To compare the efficacy of a purely transvenous cardioverter-defibrillator (ICD) system with that of a system with a supplementary subcutaneous patch. To evaluate clinical follow up of these lead arrangements that do not require thoracotomy. Design: A simplified defibrillation protocol to test two different lead arrangements during implantation, with routine clinical follow up after implantation. Setting: Tertiary referral centre for treatment of arrhythmia. Patients: 22 consecutive patients selected for implantation of an ICD because of life-threatening ventricular arrythmias (ventricular fibrillation or sustained ventricular tachycardia) of whom 20 entered the test protocol. Intervention: Implantation of an ICD with transvenously inserted intracardiac leads and a subcutaneous patch and assessment of effective defibrillation followed by testing of the purely transvenous approach. Main outcome measures: Reproducible conversion of ventricular fibrillation to sinus rhythm at a certain energy level, providing a safety margin of at least 10 J for both lead arrangements. Confirmation of efficacy during clinical follow up (mean 6 months). Results: A transvenous lead system combined with a subcutaneous axillary patch was implanted in 20/22 patients and it provided adequate and acceptable energy levels. In 10/20 tested patients a purely transvenous lead configuration provided an acceptable safety margin as well. Nine patients had clinical recurrences: all these arrhythmias were successfully converted. Conclusion: A transvenous lead system was sufficient in 50% of the patients at the time of implantation. Data on long-term clinical follow up of this arrangement are not available. The approach without thoracotomy with a subcutaneous patch is feasible and effective in most patients selected for ICD treatment.
Keywords
CONFIGURATION, IMPLANTABLE CARDIOVERTER, THRESHOLD

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Chicago
Jordaens, Luc, Jan Trouerbach, P Vertongen, Luc Herregods, Jan Poelaert, and Guido Van Nooten. 1993. “Experience of Cardioverter-defibrillators Inserted Without Thoracotomy: Evaluation of Transvenously Inserted Intracardiac Leads Alone or with a Subcutaneous Axillary Patch.” British Heart Journal 69 (1): 14–19.
APA
Jordaens, Luc, Trouerbach, J., Vertongen, P., Herregods, L., Poelaert, J., & Van Nooten, G. (1993). Experience of cardioverter-defibrillators inserted without thoracotomy: evaluation of transvenously inserted intracardiac leads alone or with a subcutaneous axillary patch. BRITISH HEART JOURNAL, 69(1), 14–19.
Vancouver
1.
Jordaens L, Trouerbach J, Vertongen P, Herregods L, Poelaert J, Van Nooten G. Experience of cardioverter-defibrillators inserted without thoracotomy: evaluation of transvenously inserted intracardiac leads alone or with a subcutaneous axillary patch. BRITISH HEART JOURNAL. 1993;69(1):14–9.
MLA
Jordaens, Luc, Jan Trouerbach, P Vertongen, et al. “Experience of Cardioverter-defibrillators Inserted Without Thoracotomy: Evaluation of Transvenously Inserted Intracardiac Leads Alone or with a Subcutaneous Axillary Patch.” BRITISH HEART JOURNAL 69.1 (1993): 14–19. Print.
@article{200616,
  abstract     = {Objectives: To compare the efficacy of a purely transvenous cardioverter-defibrillator (ICD) system with that of a system with a supplementary subcutaneous patch. To evaluate clinical follow up of these lead arrangements that do not require thoracotomy. 
Design: A simplified defibrillation protocol to test two different lead arrangements during implantation, with routine clinical follow up after implantation. 
Setting: Tertiary referral centre for treatment of arrhythmia. 
Patients: 22 consecutive patients selected for implantation of an ICD because of life-threatening ventricular arrythmias (ventricular fibrillation or sustained ventricular tachycardia) of whom 20 entered the test protocol. 
Intervention: Implantation of an ICD with transvenously inserted intracardiac leads and a subcutaneous patch and assessment of effective defibrillation followed by testing of the purely transvenous approach. 
Main outcome measures: Reproducible conversion of ventricular fibrillation to sinus rhythm at a certain energy level, providing a safety margin of at least 10 J for both lead arrangements. Confirmation of efficacy during clinical follow up (mean 6 months). 
Results: A transvenous lead system combined with a subcutaneous axillary patch was implanted in 20/22 patients and it provided adequate and acceptable energy levels. In 10/20 tested patients a purely transvenous lead configuration provided an acceptable safety margin as well. Nine patients had clinical recurrences: all these arrhythmias were successfully converted. 
Conclusion: A transvenous lead system was sufficient in 50\% of the patients at the time of implantation. Data on long-term clinical follow up of this arrangement are not available. The approach without thoracotomy with a subcutaneous patch is feasible and effective in most patients selected for ICD treatment.},
  author       = {Jordaens, Luc and Trouerbach, Jan and Vertongen, P and Herregods, Luc and Poelaert, Jan and Van Nooten, Guido},
  issn         = {0007-0769},
  journal      = {BRITISH HEART JOURNAL},
  keyword      = {CONFIGURATION,IMPLANTABLE CARDIOVERTER,THRESHOLD},
  language     = {eng},
  number       = {1},
  pages        = {14--19},
  title        = {Experience of cardioverter-defibrillators inserted without thoracotomy: evaluation of transvenously inserted intracardiac leads alone or with a subcutaneous axillary patch},
  volume       = {69},
  year         = {1993},
}