The implant of a pacemaker cardioverter-defibrillator with a system of endocardial electrodes without thoracotomy
González-Hermosillo, J.A.; Medina, V.; Martínez-Ríos, M.A.; Rey, F.; Estrada, S.; Garrido, A.; Alcedo, A.; Robledo, R.; Rodríguez, G.; Kershenovich, S.
Archivos del Instituto de Cardiologia de Mexico 63(6): 501-511
1993
ISSN/ISBN: 0020-3785 PMID: 8135591 Document Number: 413690
This article describes the first case in Mexico of an implantable pacer-cardioverter-defibrillator in a 44-year-old man with coronary artery disease and recurrent ventricular tachycardia without the need for a thoracotomy and epicardial electrodes. The patient underwent electrophysiological evaluation that revealed drug-refractory ventricular tachycardia. Endocardial catheter ablation with radiofrequency was considered and rejected due to an unstable hemodynamic state during the tachycardia. A triple electrode system using two transvenous catheter electrodes and a subcutaneous chest patch were employed. Two monophasic unsynchronized shocks were delivered with a 18 J sequential pulse technique over two distinct current pathways. The automatic pacer-cardioverter-defibrillator was implanted in the abdominal wall and demonstrated reproducible termination of ventricular fibrillation.