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Clinical outcome of patients with malignant ventricular tachyarrhythmias and a multiprogrammable implantable cardioverter-defibrillator implanted with or without thoracotomy: an international multicenter study

Author
Organization
Abstract
Objectives. The long term efficacy and safety of a third-generation implantable cardioverter-defibrillator implanted with thoracotomy and nonthoracotomy lead systems was evaluated in a multicenter international study. Background. The clinical impact of transvenous leads for nonthoracotomy implantation and pacing for bradyarrhythmias and tachyarrhythmias in implantable cardioverter defibrillator systems is not well defined. Methods. The safety of the implantation procedure and clinical outcome of 1,221 patients with symptomatic and life-threatening ventricular tachyarrhythmias who underwent implantation of a third generation cardioverter defibrillator using either a thoracotomy approach with epicardial leads (616 patients) or a nonthoracotomy approach with endocardial leads (605 patients) in a nonrandomized manner was analyzed. The implantable cardioverter defibrillator system permitted pacing, cardioversion, defibrillation, arrhythmia event memory and noninvasive tachycardia induction. Results. Successful implantation of an endocardial lead system was achieved in 605 (88.2%) of 686 patients and an epicardial system in 614 (99.7%) of 616 (p < 0.05). Perioperative 30 day mortality rate was 0.8% (1.8% including crossovers) in endocardial implant recipients compared with 4.2% (p < 0.001) in epicardial implant recipients(3.6% without crossovers, p < 0.05, respectively). Implantation mortality risk was significantly lower for nonthoracotomy systems irrespective of left ventricular ejection fraction or New York Heart Association functional class. Pacing therapies prevented need for cardioversion or defibrillation shocks in 89% of all ventricular tachycardia episodes and were comparably effective for both lead systems. Total survival rate at 2 years was significantly higher in endocardial (87.6%) than epicardial (81.9%) lead recipients (p < 0.001). Elimination of perioperative mortality from the analysis demonstrated comparable survival in both groups (p > 0.2). Conclusions. Third-generation cardioverter defibrillators with monophasic waveforms can be successfully implanted with epicardial (99.7%) and endocardial (88.2%) lead systems. We conclude that endocardial leads should be the implant technique of first choice. Improved patient management and tolerance for device therapy is achieved with the addition of antitachycardia pacemaker capability in these systems.
Keywords
SURVIVAL, THERAPY, EXPERIENCE, TRIPLE-ELECTRODE SYSTEM, ARRHYTHMIAS, COMPLICATIONS, DEVICE, SHOCKS

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MLA
Ahern, TS et al. “Clinical Outcome of Patients with Malignant Ventricular Tachyarrhythmias and a Multiprogrammable Implantable Cardioverter-defibrillator Implanted with or Without Thoracotomy: An International Multicenter Study.” JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 23.7 (1994): 1521–1530. Print.
APA
Ahern, T., Alpert, B., Bardy, G., Beckman, K., Benditt, D., Berenbom, L., Bhandari, A., et al. (1994). Clinical outcome of patients with malignant ventricular tachyarrhythmias and a multiprogrammable implantable cardioverter-defibrillator implanted with or without thoracotomy: an international multicenter study. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 23(7), 1521–1530.
Chicago author-date
Ahern, TS, BL Alpert, GH Bardy, K Beckman, DG Benditt, LD Berenbom, AK Bhandari, et al. 1994. “Clinical Outcome of Patients with Malignant Ventricular Tachyarrhythmias and a Multiprogrammable Implantable Cardioverter-defibrillator Implanted with or Without Thoracotomy: An International Multicenter Study.” Journal of the American College of Cardiology 23 (7): 1521–1530.
Chicago author-date (all authors)
Ahern, TS, BL Alpert, GH Bardy, K Beckman, DG Benditt, LD Berenbom, AK Bhandari, WN Brodine, DM Cassidy, PD Chapman, DA Chilson, ST Denker, DS Echt, TB Edem, JD Fisher, RD Fletcher, RN Fogoros, S Furman, JL Gallastegui, DC Gohn, CD Gottlieb, GS Greer, JC Griffin, CI Haffajee, SC Hammill, JJ Hayes, SKS Huang, I Smith, JM Irwin, WM Jackman, DL Janosik, M Josephson, EE Kennedy, HA Kopelman, MS Kremers, J Kron, MH Lehman, AR Leon, BD Lindsay, RM Luceri, PL Ludmer, R Mahmud, TA Mattioni, JH McCelland, RJ McCowan, WM Miles, F Morady, GV Naccarelli, JS Osborn, MF O’Toole, CT Peter, EV Platia, JG Porterfield, M Pritzker, TD Sellers, AD Sharma, RA Shiroff, SR Spielman, A Stamato, RT Steinman, RJ Sung, CD Swerdlow, DF Switzer, JL Trantham, PF Walter, KR Whelan, DJ Wilber, RA Winkle, M Zaher, DP Zipes, SJ Connolly, P Dorian, E Downar, M Dubuc, S Gulamhusein, LB Mitchell, MH Sami, ASL Tang, R Yee, E Aliot, J Almendral, J Amlie, D Andresen, G Benedini, A Bertulla, C Blomstrom Lundqvist, J Brachmann, G Breithardt, AJ Camm, M Clarke, P Coumel, DW Davies, S Favale, F Furlanello, H Heuer, W Hopp, Luc Jordaens, S Kacet, LJ Kappenberger, W Klein, KH Kuck, HE Kulbertus, S Levy, B Luderitz, R Lyttwin, JM McComb, CM Serrano, AW Nathan, IWP Obel, OJ Ohm, C Pappone, EJ Perrins, M Rosenqvist, E Rowland, G Sabin, H Schmidinger, E Sowton, K Steinbach, G Steinbeck, R Sutton, H Tillmanns, PP Touboul, M Wehr, HJJ Wellens, and J Witte. 1994. “Clinical Outcome of Patients with Malignant Ventricular Tachyarrhythmias and a Multiprogrammable Implantable Cardioverter-defibrillator Implanted with or Without Thoracotomy: An International Multicenter Study.” Journal of the American College of Cardiology 23 (7): 1521–1530.
Vancouver
1.
Ahern T, Alpert B, Bardy G, Beckman K, Benditt D, Berenbom L, et al. Clinical outcome of patients with malignant ventricular tachyarrhythmias and a multiprogrammable implantable cardioverter-defibrillator implanted with or without thoracotomy: an international multicenter study. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. 1994;23(7):1521–30.
IEEE
[1]
T. Ahern et al., “Clinical outcome of patients with malignant ventricular tachyarrhythmias and a multiprogrammable implantable cardioverter-defibrillator implanted with or without thoracotomy: an international multicenter study,” JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, vol. 23, no. 7, pp. 1521–1530, 1994.
@article{8088543,
  abstract     = {Objectives. The long term efficacy and safety of a third-generation implantable cardioverter-defibrillator implanted with thoracotomy and nonthoracotomy lead systems was evaluated in a multicenter international study. 
Background. The clinical impact of transvenous leads for nonthoracotomy implantation and pacing for bradyarrhythmias and tachyarrhythmias in implantable cardioverter defibrillator systems is not well defined. 
Methods. The safety of the implantation procedure and clinical outcome of 1,221 patients with symptomatic and life-threatening ventricular tachyarrhythmias who underwent implantation of a third generation cardioverter defibrillator using either a thoracotomy approach with epicardial leads (616 patients) or a nonthoracotomy approach with endocardial leads (605 patients) in a nonrandomized manner was analyzed. The implantable cardioverter defibrillator system permitted pacing, cardioversion, defibrillation, arrhythmia event memory and noninvasive tachycardia induction. 
Results. Successful implantation of an endocardial lead system was achieved in 605 (88.2%) of 686 patients and an epicardial system in 614 (99.7%) of 616 (p < 0.05). Perioperative 30 day mortality rate was 0.8% (1.8% including crossovers) in endocardial implant recipients compared with 4.2% (p < 0.001) in epicardial implant recipients(3.6% without crossovers, p < 0.05, respectively). Implantation mortality risk was significantly lower for nonthoracotomy systems irrespective of left ventricular ejection fraction or New York Heart Association functional class. Pacing therapies prevented need for cardioversion or defibrillation shocks in 89% of all ventricular tachycardia episodes and were comparably effective for both lead systems. Total survival rate at 2 years was significantly higher in endocardial (87.6%) than epicardial (81.9%) lead recipients (p < 0.001). Elimination of perioperative mortality from the analysis demonstrated comparable survival in both groups (p > 0.2). 
Conclusions. Third-generation cardioverter defibrillators with monophasic waveforms can be successfully implanted with epicardial (99.7%) and endocardial (88.2%) lead systems. We conclude that endocardial leads should be the implant technique of first choice. Improved patient management and tolerance for device therapy is achieved with the addition of antitachycardia pacemaker capability in these systems.},
  author       = {Ahern, TS and Alpert, BL and Bardy, GH and Beckman, K and Benditt, DG and Berenbom, LD and Bhandari, AK and Brodine, WN and Cassidy, DM and Chapman, PD and Chilson, DA and Denker, ST and Echt, DS and Edem, TB and Fisher, JD and Fletcher, RD and Fogoros, RN and Furman, S and Gallastegui, JL and Gohn, DC and Gottlieb, CD and Greer, GS and Griffin, JC and Haffajee, CI and Hammill, SC and Hayes, JJ and Huang, SKS and Smith, I and Irwin, JM and Jackman, WM and Janosik, DL and Josephson, M and Kennedy, EE and Kopelman, HA and Kremers, MS and Kron, J and Lehman, MH and Leon, AR and Lindsay, BD and Luceri, RM and Ludmer, PL and Mahmud, R and Mattioni, TA and McCelland, JH and McCowan, RJ and Miles, WM and Morady, F and Naccarelli, GV and Osborn, JS and O'Toole, MF and Peter, CT and Platia, EV and Porterfield, JG and Pritzker, M and Sellers, TD and Sharma, AD and Shiroff, RA and Spielman, SR and Stamato, A and Steinman, RT and Sung, RJ and Swerdlow, CD and Switzer, DF and Trantham, JL and Walter, PF and Whelan, KR and Wilber, DJ and Winkle, RA and Zaher, M and Zipes, DP and Connolly, SJ and Dorian, P and Downar, E and Dubuc, M and Gulamhusein, S and Mitchell, LB and Sami, MH and Tang, ASL and Yee, R and Aliot, E and Almendral, J and Amlie, J and Andresen, D and Benedini, G and Bertulla, A and Blomstrom Lundqvist, C and Brachmann, J and Breithardt, G and Camm, AJ and Clarke, M and Coumel, P and Davies, DW and Favale, S and Furlanello, F and Heuer, H and Hopp, W and Jordaens, Luc and Kacet, S and Kappenberger, LJ and Klein, W and Kuck, KH and Kulbertus, HE and Levy, S and Luderitz, B and Lyttwin, R and McComb, JM and Serrano, CM and Nathan, AW and Obel, IWP and Ohm, OJ and Pappone, C and Perrins, EJ and Rosenqvist, M and Rowland, E and Sabin, G and Schmidinger, H and Sowton, E and Steinbach, K and Steinbeck, G and Sutton, R and Tillmanns, H and Touboul, PP and Wehr, M and Wellens, HJJ and Witte, J},
  issn         = {0735-1097},
  journal      = {JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY},
  keywords     = {SURVIVAL,THERAPY,EXPERIENCE,TRIPLE-ELECTRODE SYSTEM,ARRHYTHMIAS,COMPLICATIONS,DEVICE,SHOCKS},
  language     = {eng},
  number       = {7},
  pages        = {1521--1530},
  title        = {Clinical outcome of patients with malignant ventricular tachyarrhythmias and a multiprogrammable implantable cardioverter-defibrillator implanted with or without thoracotomy: an international multicenter study},
  volume       = {23},
  year         = {1994},
}