Implantation of transvenous nonthoracotomy cardioverter-defibrillator systems in patients with permanent endocardial pacemakers

• Published in: The American heart journal Vol. 129; no. 1; pp. 45 - 53
• Main Authors: Brooks, Ross, Garan, Hasan, McGovern, Brian A., Ruskin, Jeremy N.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 1995; Elsevier
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arrhythmias, Cardiac - diagnostic imaging; Arrhythmias, Cardiac - therapy; Biological and medical sciences; Defibrillators, Implantable; Electrocardiography; Electrodes, Implanted; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Equipment Failure; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Pacemaker, Artificial; Radiography; Thoracotomy; Human; Intensive cardiocirculatory care; Instrumental stimulation; Association; Implanted; Pacemaker; Instrumentation therapy; Endocardium; Surgical approach; Defibrillation; Defibrillator
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(95)90041-1

Among 177 patients in whom a nonthoracotomy approach was initially used to implant a cardioverter-defibrillator system, 11 (6%) patients also received a separately implanted permanent pacemaker. The main problem encountered in these patients were previously implanted unipolar pacemakers ( n = 3) and ventricular pacing leads positioned at the right ventricular apex, the latter interfering with optimal placement of the tripolar implantable cardioverter-defibrillator (ICD) lead ( n = 9). The approaches used to solve these problems were individualized and included placement of the ICD sensing lead at the right ventricular outflow tract ( n = 3), initial placement ( n = 1) or subsequent repositioning ( n = 2) of the right ventricular pacing lead at the outflow tract, upgrade from unipolar to bipolar systems ( n = 2), reprogramming from the DDD to AAI mode ( n = 2), inactivation of the pacemaker ( n = 1), and simultaneous placement of a single-chamber atrial pacemaker with the ICD lead ( n = 2). These revisions fulfilled the pacing needs in each patient and prevented unfavorable sensing interaction between the two systems.