| Determinants of successful nonthoracotomy cardioverter-defibrillator implantation: experience in 101 patients using two different lead systems. | |
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MedLine Citation:
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PMID: 8245336 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study was conducted to identify the determinants of successful nonthoracotomy cardioverter-defibrillator implantation. BACKGROUND: Until recently, either median sternotomy or thoracotomy was necessary to implant the electrodes used for internal cardioverter-defibrillator systems. A number of manufacturers have developed nonthoracotomy lead systems comprising two transvenous coil electrodes and a subcutaneous patch electrode. At present, the factors associated with the success or failure of a nonthoracotomy approach are unknown. METHODS: A total of 101 consecutive patients requiring a cardioverter-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 predictors 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. |
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Authors:
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R Brooks; H Garan; D Torchiana; G J Vlahakes; G Jackson; J Newell; B A McGovern; J N Ruskin |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 22 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1993 Dec |
Date Detail:
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Created Date: 1993-12-28 Completed Date: 1993-12-28 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1835-42 Citation Subset: AIM; IM |
Affiliation:
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Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Actuarial Analysis Algorithms Defibrillators, Implantable* / statistics & numerical data Electrodes, Implanted Equipment Design Female Heart / anatomy & histology Humans Male Middle Aged Multivariate Analysis Prospective Studies Sex Factors Sternum / surgery Tachycardia, Ventricular / epidemiology, therapy* Thoracotomy* Ventricular Fibrillation / epidemiology, therapy* |
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