Consistent Subcutaneous Prepectoral Implantation of a New Implantable Cardioverter Defibrillator

To describe the use of a new implantable cardioverter defibrillator (ICD) that can be placed in the prepectoral region rather than implanted in the abdominal wall. We report the experience of placement of this new ICD in the prepectoral region in 13 patients from Sept. 28, 1993, through Jan. 10, 1994, at the Mayo Clinic. Thirteen consecutive patients offered this new ICD underwent placement of transvenous defibrillation leads, and the pulse generator was placed in a pocket formed in the subcutaneous, prepectoral space. Testing ensured a defibrillation threshold of 24 J or less. In all 13 patients, the pulse generator could be placed in the subcutaneous, prepectoral space. In all except one patient, acceptable defibrillation thresholds were achieved by using lead systems placed totally transvenously. Only one patient required placement of a subcutaneous patch. All but two patients were dismissed from the hospital within 3 days after the ICD implantation. Consistent subcutaneous, prepectoral placement of this new ICD pulse generator is possible. Because the entire procedure can be performed in the pacemaker implantation room, the potential exists for decreasing the duration of the hospitalization and associated costs.