Epicardial implantation of the automatic implantable defibrillator by left subcostal thoracotomy.

The automatic implantable defibrillator is a valuable addition to the management of certain patients with ventricular tachycardia and/or fibrillation. The original technique required placement of two transvenous electrodes and an epicardial electrode via a left thoracotomy. We have successfully developed an all-epicardial approach using a left subcostal thoracotomy. Previous experience with epicardial pacemaker implantation by this approach suggested it would be a good technique for implantation of the automatic defibrillator. Early results with this approach have encouraged its continued use.