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January 1, 1995Pacing and Clinical Electrophysiology

Epicardial and Nonthoracotomy Defibrillation Lead Systems Combined with a Cardioverter Defibrillator

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Why the study?

Does a nonthoracotomy defibrillation lead system provide similar safety and efficacy compared to an epicardial patch system in patients receiving a cardioverter defibrillator?

Population

67 patients who underwent implantation of the Ventritex Cadence cardioverter defibrillator

Comparison

Nonthoracotomy CPI Endotak defibrillation lead… vs Epicardial patch (EPI) defibrillation lead system

Design

Cohort

Follow-up

mean 12 +/- 8 months

Authors

HTHans‐Joachim TrappeUniversitätsklinik Marien Hospital HerneHFHans‐Gerd FieguthKinderkrankenhaus auf der BultPPP PfitznerUniversitätsklinik Marien Hospital Herne

Discussion

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Implication

Nonthoracotomy leads showed similar intraoperative DFT and first-shock success to epicardial systems; leaves open long-term equivalence and warrants prospective confirmation.

Key Points

  • Compare intraoperative defibrillation thresholds and long-term clinical efficacy between epicardial patch and nonthoracotomy transvenous lead systems paired with an implantable cardioverter defibrillator.
  • Reviewed 67 patients receiving a Ventritex Cadence defibrillator equipped with either epicardial patches (EPI, n=25) or nonthoracotomy transvenous leads (ENDO, n=42).
  • Assessed intraoperative defibrillation thresholds (DFT), perioperative mortality, and arrhythmia conversion rates across a mean follow-up of 12 ± 8 months.
  • Intraoperative DFT was 13 ± 9 joules for EPI versus 15 ± 8 joules for ENDO (P = NS), with zero perioperative deaths and no sudden cardiac deaths in either cohort.
  • First-shock termination for rapid ventricular tachycardia (≥ 222 beats/min) or ventricular fibrillation succeeded in 76% of EPI attempts and 75% of ENDO attempts, while antitachycardia pacing succeeded in 93% (660/708) and 88% (414/470) of slower episodes, respectively (P = NS).

Structured PICO

Does a nonthoracotomy defibrillation lead system provide similar safety and efficacy compared to an epicardial patch system in patients receiving a cardioverter defibrillator?

P
Population
67 patients who underwent implantation of the Ventritex Cadence cardioverter defibrillator
I
Intervention
Nonthoracotomy CPI Endotak (ENDO) defibrillation lead system
C
Comparator
Epicardial patch (EPI) defibrillation lead system
O
Outcome
Intraoperative defibrillation threshold (DFT) and long-term clinical outcomes including mortality, spontaneous arrhythmia episodes, and shock efficacy

A nonthoracotomy defibrillation lead system is safe and effective, demonstrating clinical results and defibrillation thresholds that are not significantly different from epicardial lead systems.

Cite This Study

Trappe et al. (1995) studied this question.

synapsesocial.com/papers/6a8ce49e748301e7973019dfhttps://doi.org/10.1111/j.1540-8159.1995.tb02490.x

Topics

Ventricular arrhythmiasCardiac device therapy
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Clinical Results with Nonthoracotomy ICD Systems1993 · 41 citations
  2. 2Termination of Malignant Ventricular Arrhythmias with an Implanted Automatic Defibrillator in Human Beings1980 · 1,367 citations
  3. 3Defibrillation Thresholds and Perioperative Mortality Associated with Endocardial and Epicardial Defihrillation Lead Systems1993 · 66 citations
  4. 4Role of Antitachycardia Pacing in Patients with Third Generation Cardioverter Defibrillators1994 · 37 citations
  5. 5Initial Experience with a New Transvenous Defibrillation System1993 · 27 citations