We review our experience with the transvenous Medtronic Pacer Cardioverter
Defibrillator System (Model 7217B), a multifunction implantable pacer
defibrillator combined with a transvenous lead system (Transvene). From April 1991 to October 1992, we implanted this device in 19 consecutive patients (11 men and 8 women; average age, 56.5 years). Nine patients (47.4%), 5 with
coronary artery disease and 4 with
dilated cardiomyopathy, had an ejection fraction of < 30%. The average
operative time was 129 minutes. In 18 patients (94.7%), the transvenous lead system provided effective sensing, pacing, and defibrillation during intraoperative testing. In each of these cases, the defibrillation threshold was less than 18 J. In 1 patient (5.3%), it was necessary to switch to epicardial leads, which were implanted through a left
thoracotomy. All patients were extubated in the recovery room. The average
hospital stay was 8 days. There was no early mortality or morbidity. During a maximum follow-up period of 17 months (mean, 9.2 months), no
sudden death occurred. The implantable system terminated 245
ventricular tachycardia episodes in 14 patients (73.7%) and 82
ventricular fibrillation episodes in 13 patients (68.4%). Two hundred eleven (86.1%) of the
ventricular tachycardia episodes were resolved by antitachycardia pacing alone. In 2 patients (10.5%), the caval
electrode became dislocated; repositioning of the
electrode was followed by repeat defibrillation threshold evaluation. Our experience shows that the transvenous Medtronic Pacer Cardioverter
Defibrillator System provides safe, effective treatment of
ventricular tachyarrhythmias. Because the perioperative mortality and morbidity are extremely low, use of this device may be particularly beneficial in patients with a high operative risk. Moreover, the lower number of unpleasant therapeutic shocks should increase patient a acceptance of the device.