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Transvenous Defibrillators

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Evolution of Transvenous Defibrillators

Defibrillators are implanted for prevention of sudden cardiac death. They are different from pacemakers since pacemakers only speed up slow heart rates while defibrillators can deliver high-energy shocks to reset or re-start the heart during dangerous heart rhythm disturbances. Essentially, they perform a similar task to the paddles that an EMT would use on the field but do this automatically and within seconds of a life-threatening episode. There are two varieties of defibrillators: subcutaneous and transvenous. The transvenous type is much more common.

Transvenous defibrillators are implanted on the chest wall through a small incision (approximately 5 cm) followed by accessing the axillary, cephalic, or subclavian vein. The wire is inserted through the vein into the heart. This is attached to the defibrillator generator, the generator is placed under the skin, and the skin is closed with sutures. All transvenous defibrillators also have the ability to act as a pacemaker.

Subcutaneous defibrillators are implanted on the chest wall, but closer to the axilla (armpit) region through a 5 to 10 cm incision. An additional incision is made along the sternum (middle of the chest) where a wire is snaked under the skin (not in the vein). The wire is attached to the defibrillator generator, the generator is placed under the skin, and the skin is closed with sutures.

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