Author + information
- Received March 11, 1993
- Revision received July 14, 1993
- Accepted July 23, 1993
- Published online December 1, 1993.
- Ross Brooks, MD∗,
- Hasan Garan, MD,
- Facc David Torchiana, MD,
- Gus J. Vlahakes, MD,
- Guy Jackson, PA,
- John Newell, BA,
- Brian A. McGovern, MD and
- Jeremy N. Ruskin, MD, FACC
- ↵∗Address for correspondence: Dr. Ross Brooks, Cardiac Unit, Bulfinch 019, Massachusetts General Hospital, Boston, Massachusetts 02114.
Objectives. This study was conducted to identify the determinants of Successful nonthoractomy cardioverter-defibrillator implantation.
Background. Until recently, either sternotomy or thoracotomy was necessary to Implant the electrodes used for internal cardioverter-defibrillator systems. A number of manufactures have developed nonthoracotomy lead Systems comprising two transvenous coil electrodes and a subcutaneous patch electrode. At present, the factors associated with the success or feilure of a nonthoracotomy approach are unknown.
Methods. A total of 101 consecutive patients requiring a cadioverter-defibrillator underwent an initial nonthoracotomy approach. Factors associated with successful nonthoracotomy implantation were prospectively determined.
Results. A nonthoracotomy system was implanted in 72 (71%) of 101 patients. Twenty-nine patients (29%) required thoracotomy. Univariate of successful nonthoracotomy implantation included smaller cardiac size (p < 0.0001), smaller cardiothoracic ratio (p < 0.0002), QRS duration <120 ms (p = 0.003), female gender (p = 0.006), ventricular fibrillation as the presenting arrhythmia (p = 0.03) and smaller echocardiographic left ventricular size (p = 0.04). Multivariate predictors included smaller cardiac size (p < 0.002) and female gender (p < 0.007). Total actuarial survival over a mean (± SD) follow-up interval of 12 ± 7 months was 91 ± 0.03% and was not different in the thoracotomy and nonthoracotomy groups.
Conclusions. A nonthoracotomy cardioverter-defibrillator system can be implanted in a majority of patients. Smaller cardiac size and female gender are associated with a high probability of successful implantation.
- Received March 11, 1993.
- Revision received July 14, 1993.
- Accepted July 23, 1993.