With the advent of nonthoracotomy leads and smaller devices, implantation techniques for implantable cardioverter defibrillators (ICDs) have been simplified to the point where electrophysiologists are the primary implanters and the surgical procedure approached the ease of a pacemaker implantation. The aim of this study was to review the clinical outcome of the first forty transvenous ICDs at Cairo University Hospitals. We studied 30 consecutive patients, (27 males and 3 females, mean age 48+14 years), presenting with drug refractory ventricular tachycardia. Nineteen pts had coronary artery disease, 3 had dilated cardiomyopathy while 8 pts had no underlying heart disease. Two implantation techniques were used: abdominal route in 11 pts, and pectoral route in 19 pts. Cumulative follow up period averaged 48 months for abdominal implants and 35 months for pectoral implants. General anesthesia was used in all abdominal implants and in 9 pts of pectoral implants while conscious sedation was used in 11 pts of pectoral implants. Integrated bipolar leads were used in all abdominal and 10 pectoral implants while true bipolar leads were used in 10 pectoral implants. The procedure time was significantly shorter for the pectoral implants (79.75%+12.6 vs 168.5+33 mins, P < 0.005). The hospital stay was also significantly shorter for the pectoral implants (3+1.5 days vs 8+2.1 days, P < 0.005). There was no difference in the defibrillation threshold (mean = 14.20+3 J). Sixty percent of the abdominal group were alive vs 90% of the pectoral implants by the end of the follow up period. There was a single perioperative mortality due to generator-adaptor malfunction in abdominal group. In conclusion: Besides the ease of implantation, shorter implantation time and hospital stay, and lower costs, the pectoral implantation is preferred for the lower rate of complications and consequently lower rate of morbidity and mortality compared to the abdominal route.