Ventricular pacing with epigastric transdiaphragmatic electrodes. Long-term follow-up and comparison with other implantation methods.

One hundred eighty-seven electrode systems were implanted in 158 consecutive patients--30 systems implanted by thoracotomy, 98 transvenous, and 52 epigastric transdiaphragmatic systems--and the long-term results were compared. With electrodes placed by thoracotomy there was a high rate of complication (76 per cent), prolonging the initial hospitalization (33 per cent) and necessitating frequent rehospitalizations (56 per cent). With transvenous electrodes the complication rate was 39 per cent (16 per cent during the first hospitalization, 28 per cent necessitating rehospitalization). With epigastric transdiaphragmatic electrodes these figures were, respectively, 15, 12, and 6 per cent. The most frequent complications with transvenous electrodes were displacement (15 per cent), ulcerations, and local infection; all were abolished when the epigastric approach was used. Threshold elevation was not more frequent with epigastric electrodes (sutured to the right ventricle) than with the other techniques. Four per cent of the epigastric electrodes caused complications severe enough to require another mode of pacing, contrasting with 18 and 26 per cent, respectively, for the transvenous and transthoracic electrodes.