[Medium-term clinical experience with automatic transvenous defibrillators implanted in the chest area without subcutaneous electrodes].

From March 1992 to April 1996 a pectoral biphasic transvenous implantable cardioverter defibrillator without subcutaneous leads was implanted in 35 patients with life threatening ventricular tachyarrhythmias. Mean age was 58 +/- 9 years; 23 patients had coronary artery disease, 10 non ischemic dilated cardiomyopathy and 2 arrhythmogenic right ventricular dysplasia. All were in NYHA functional class I and II and 4 in class III: mean ejection fraction was 35 +/- 12%. The mean duration of the implantation procedure was 85 +/- 35 min. The mean defibrillation threshold, measured in 23 active-CAN devices was 8.8 +/- 5 J. There were no operative complications except in one case of transient ischemic electromechanical dissociation. The mean hospital stay from the time of implant to predischarge evaluation was 6.2 +/- 2 days. The average follow-up period was 18.5 +/- 11 months. Two patients had non sudden and non arrhythmic cardiac death in the third and sixth month, respectively. In 19 patients 171 implantable cardioverter defibrillator interventions were reported: in 5 patients five inappropriate interventions were reported and in the remaining 14 were reported: 35 ventricular fibrillation and 131 ventricular tachycardia. The short duration of the procedure, brief hospitalization with very low perioperative morbidity, high efficacy and low mid-term complications give a new image to this therapeutic option.