A new generation of defibrillators has been introduced that do not require a thoracotomy. The purpose of this report was to examine 100 consecutive nonthoracotomy implantations at our institution and compare them with a series of 102 patients undergoing thoracotomy implantations by the same surgeon over a 4-year period between August 1989 and September 1994. The two groups were comparable for age, sex, comorbidity, cardiac disease status, ejection fraction, and electrophysiologic presentation. Nonthoracotomy systems were implanted successfully in 94% of patients. Patients undergoing a nonthoracotomy implantation had significantly shorter intensive care unit (1.7 ± 1.7 versus 3.3 ± 3.9 days; p < 0.005) and postoperative stays (5.0 ± 2.8 versus 9.5 ± 5.6 days; p < 0.001) than patients undergoing a thoracotomy approach. This was due to a significant decrease in the incidence of postoperative complications from 29% in the thoracotomy group to 11% in the nonthoracotomy group (p < 0.001). There was no significant difference in overall mortality rates. Nonthoracotomy systems are implantable in the majority of patients and are associated with less morbidity and shorter hospital stays than traditional thoracotomy approaches.