Epicardial Implantation of the Automatic Implantable Defibrillator by Left Subcostal Tboracotomy

The automatic implantable defibrillator is a valuable addition to the management of certain patients with ventricular tachycardia and/or fibrillation. The original technique required placement of two transvenous electrodes and an epicardial electrode via a left thoracotomy. We have successfully developed an all‐epicardial approach using a left subcostal thoracotomy. Previous experience with epicardial pacemaker implantation by this approach suggested it would he a good technique for implantation of the automatic defibrillator. Early results with this approach have encouraged its continued use.