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

doi:10.1001/jama.1988.03720010047039

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

Sanjeev Saksena, MD;
Victor Parsonnet, MD

From The Fannie E. Rippel Cardiac Electrophysiology Laboratory (Dr Saksena) and The Pacemaker Center (Dr Parsonnet), Newark Beth Israel Medical Center—The University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark.

Abstract

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)