{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:15:56Z","timestamp":1760955356116},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1994,8]]},"abstract":"\n BACKGROUND<\/jats:title>\n Traditional lead systems for implantable cardioverter defibrillators (ICDs) require a thoracotomy for placement. Nonthoracotomy lead systems are available and are usually implanted by an electrophysiologist and a surgeon. The purpose of this study was to prospectively evaluate the safety and efficacy of ICD implantation with a nonthoracotomy lead system by electrophysiologists.<\/jats:p>\n <\/jats:sec>\n \n METHODS AND RESULTS<\/jats:title>\n A consecutive series of 100 patients (mean age, 61 +\/- 13 years, +\/- SD) underwent ICD implantation with a nonthoracotomy lead system while intubated and under general anesthesia. Seventy-seven patients had coronary artery disease, 15 had idiopathic cardiomyopathy, 6 had miscellaneous heart disease, and 2 had structurally normal hearts. The mean ejection fraction was 0.29 +\/- 0.13. Sixty-eight patients had suffered a cardiac arrest, and 32 had had ventricular tachycardia or syncope. All patients except 9 underwent electrophysiological testing and had failed 1 +\/- 1 drug trials before ICD implantation. Three types of nonthoracotomy lead systems were used. The nonthoracotomy lead with an ICD was successfully implanted in 96 patients (96%). Of the unsuccessful implants, 1 patient did not have venous access, the passive fixation lead in 1 would not remain lodged, 1 had elevated defibrillation thresholds, and 1 developed a hemopneumothorax while venous access was being obtained. The mean defibrillation threshold was 17 +\/- 6 J. The mean procedure duration was 161 +\/- 57 minutes. When a subcutaneous patch was used (n = 58), the procedure duration was 189 +\/- 5 minutes, and when a subcutaneous patch was not required (n = 40), the procedure lasted 123 +\/- 37 minutes (P < .0001). Patients remained in the hospital 4.5 +\/- 4.1 days after implantation, with no procedure-related deaths. Acute complications occurred in 10 patients; 2 had lead dislodgments, 1 with previous abdominal surgery had his abdominal cavity entered (without other complications) while the ICD pocket was being made, 1 had postoperative heart failure, 1 developed a large hematoma when anticoagulation therapy was initiated, 3 required reintubation because of excessive anesthesia, 1 developed superficial cellulitis, and 1 developed a hemopneumothorax secondary to a lacerated subclavian vein. During 6 +\/- 3 months of follow-up, 2 patients developed lead fractures.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n (1) Electrophysiologists can implant an ICD with a nonthoracotomy lead system safely and with a high success rate; (2) use of a subcutaneous patch correlates with longer procedure durations; and (3) special precautions should be taken in patients with previous abdominal surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/01.cir.90.2.868","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:34:42Z","timestamp":1339461282000},"page":"868-872","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":58,"title":["Implantation by electrophysiologists of 100 consecutive cardioverter defibrillators with nonthoracotomy lead systems."],"prefix":"10.1161","volume":"90","author":[{"given":"S A","family":"Strickberger","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J D","family":"Hummel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Daoud","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Niebauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B D","family":"Williamson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K C","family":"Man","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Horwood","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Schmittou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S J","family":"Kalbfleisch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J J","family":"Langberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 18109-0022."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/pdf\/10.1161\/01.CIR.90.2.868","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T15:49:14Z","timestamp":1715528954000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.90.2.868"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1994,8]]},"references-count":0,"journal-issue":{"issue":"2","published-print":{"date-parts":[[1994,8]]}},"alternative-id":["10.1161\/01.CIR.90.2.868"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.90.2.868","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1994,8]]},"assertion":[{"value":"1994-08-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}