A subcutaneous lead array for implantable cardioverter defibrillators.

Two patients received an implantable cardioverter defibrillator with the combination of a transvenous lead and a subcutaneous lead array with three branches. This approach allowed us to find low defibrillation thresholds in both patients (< or = 10 and < or = 15 joules [J], respectively), which was impossible with a transvenous catheter. In a third patient, a crinkled subcutaneous patch was replaced by an array. The defibrillation threshold with the array was < or = 20 J, as opposed to > 24 J with the patch. No surgical problems occurred. The subcutaneous array is a technical improvement for the therapy with implantable defibrillators, when a single catheter system is not sufficient to ensure a safety margin for defibrillation, or when surgical or postsurgical problems occur with a subcutaneous patch.