Epicardial Implantation of the Automatic Implantable Cardioverter‐Defibrillator by Left Subcostal Thoracotomy

L awrie GM, et al : Epicardial implantation of the automatic implantable cardioverter‐defibrillator by left subcostal thoracotomy . The left subcostal thoracotomy technique has been developed for implantation of an all‐epicardial lead System for the automatic implantable cardioverter‐defibrillator. (AICD) Experience is reported in 15 patients. Advantages of this approach have proven to be: safety and low surgical morbidity; good thresholds; absence of lead dislodgment during AICD discharge; absence of complications of transvenous leads; a deep position of the AICD unit which protects against skin erosion and is cosmetically pleasing. No patient has required revision of the initial leads and chronic lead thresholds have been stable. Because of this favorable experience, we recommend the left subcostal thoracotomy approach as the procedure of choice for primary implantation of the AICD .