Automatic Implantable Cardioverter Defibrillator: Surgical Approaches for Implantation

R. B. Shepard, M. D. Goldin, G. M. Lawrie, L. Watkins, R. A. Winkle, M. M. Mower, A. C. Thomas, S. Nisam

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Surgical approaches for implantation of the automatic cardioverter defibrillator are sternotomy, left thoracotomy, subxiphoid, and subcostal. Although any one of these may be combined with insertion of one or more of the electrodes transvenously, surgical entry into the chest is required for every noninvestigational defibrillator implantation operation. The approaches differ in exposure provided for selecting electrode sites and for handling untoward events, in amount and location of tissue that must be divided or dissected, and in average time required. The operation is an electrical one. Its purpose is to obtain reliable rhythm sensing so that defibrillation or cardioversion shocks will occur only when necessary, and to obtain low enough defibrillation thresholds for shocks of 30 joules or less to have a 10‐joule defibrillation safety margin. Many of the patients have had previous cardiac operations. They usually have low or very low ejection fractions. lntraoperative electrophysiological testing with often multiple defibrillation episodes is required. The choice of approach varies with the state of the patient, the institutional experience, and the surgeon. This article describes techniques, and the advantages and disadvantages of the four approaches as used by four surgeons in four different institutions.

Original languageEnglish (US)
Pages (from-to)208-224
Number of pages17
JournalJournal of cardiac surgery
Issue number3
StatePublished - Sep 1992


  • defibrillation
  • implantable cardioverter defibrillator
  • surgical technique
  • ventricular fibrillation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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