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The Annals of Thoracic Surgery, Vol 52, 1052-1057, Copyright © 1991 by The Society of Thoracic Surgeons

ARTICLES

Effect of AICD patch electrodes on the diastolic pressure-volume curve in pigs

JS Auteri, V Jeevanandam, MR Bielefeld, JA Sanchez and HM Spotnitz
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032.

Although the automatic implantable cardioverter defibrillator (AICD) is effective against malignant ventricular arrhythmias, the effects of AICD patches on left ventricular diastolic properties have not been defined. Accordingly, extrapericardial (group E, n = 5) or intrapericardial (group I, n = 6) AICD patches were implanted through a median sternotomy in 11 anesthetized pigs. Six weeks later, using a left thoracotomy, the hearts were arrested with hypothermic cardioplegia. A balloon catheter was inserted into the left ventricle through the aortic root, and pressure-volume curves were measured before and after sequential removal of patches and pericardium. A dense intrapericardial fibrotic reaction in group I was not present in group E. Normalized left ventricular filling volumes in group E were significantly larger at pressures of 5.1 to 10, 15.1 to 20, and 20.1 to 28 mm Hg compared with group I (p less than 0.05). We conclude that intrapericardial AICD patches adversely affect left ventricular diastolic pressure-volume relations and recommend that AICD patches be placed in the extrapericardial location clinically whenever possible.


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