The automatic implantable cardioverter-defibrillator. Clinical experience, complications, and follow-up in 25 patients.

Twenty-five patients with recurrent ventricular tachyarrhythmias underwent implantation of an automatic implantable cardioverter-defibrillator. The mean length of follow-up was 11.9 +/- 10.8 months. Before the implantation, the patients had survived one or more cardiac arrests (mean, 1.7; range, 1 to 4) and episodes of syncope (mean, 2.2; range, 2 to 3) and had received 6.0 +/- 1.0 antiarrhythmic drug trials. The in-hospital complications included death (two patients), reoperation (one patient), intraoperative myocardial infarction (one patient), sensing-failure (one patient), infection (five patients), and pocket seroma (two patients). The posthospital complications included device failure (four patients), device deactivation (one patient), and inappropriate discharge (two patients). The device discharged appropriately in seven patients due to sustained ventricular tachycardia. During electrophysiologic measurements, the energy requirement for successful cardioversion-defibrillation was related to the type of ventricular arrhythmia induced (monomorphic or pleomorphic ventricular tachycardia or fibrillation). Ventricular tachycardia acceleration occurred in ten patients (40%). No significant changes were found in the size of the electrograms or in the cardioversion threshold during early and late follow-up measurements. Life table analysis showed a 12-month survival rate of 86% and an arrhythmic death survival rate of 100%. We confirm the improved rate of survival in this high-risk group of patients, despite significant complications.

[1]  P E Oyer,et al.  Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator. , 1985, Circulation.

[2]  P. D. Chapman,et al.  The automatic implantable cardioverter-defibrillator: evaluating suspected inappropriate shocks. , 1986, Journal of the American College of Cardiology.

[3]  P R Reid,et al.  The automatic implantable defibrillator. , 1980, American heart journal.

[4]  E. Prystowsky,et al.  Survivors of cardiac arrest: prevention of recurrence by drug therapy as predicted by electrophysiologic testing or electrocardiographic monitoring. , 1986, The American journal of cardiology.

[5]  R. Winkle,et al.  Mortality in patients with implanted automatic defibrillators. , 1983, Annals of internal medicine.

[6]  T. Guarnieri,et al.  Implantation of the automatic defibrillator: Current surgical techniques , 1986 .

[7]  P R Reid,et al.  Clinical Performance of the Implantable Cardioverter‐Defibrillator , 1984, Pacing and clinical electrophysiology : PACE.

[8]  A. Castellanos,et al.  The Automatic Implantable Cardioverter Defibrillator: Results, Observations, and Comments , 1986, Pacing and clinical electrophysiology : PACE.

[9]  P. R. Reid,et al.  Management of sustained ventricular tachycardia , 1985 .

[10]  J. Fisher,et al.  Implantable Pacers for Tachycardia Termination: Stimulation Techniques and Long‐Term Efficacy , 1986, Pacing and clinical electrophysiology : PACE.

[11]  M. Josephson,et al.  The automatic implantable cardioverter-defibrillator: efficacy, complications, and device failures. , 1986, Annals of internal medicine.

[12]  V L Gott,et al.  Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. , 1980, The New England journal of medicine.

[13]  G. Lawrie,et al.  Epicardial implantation of the automatic implantable cardioverter-defibrillator by left subcostal thoracotomy , 1986 .

[14]  M. Josephson,et al.  Catheter Ablation for Control of Ventricular Tachycardia: A Report of the Percutaneous Cardiac Mapping and Ablation Registry , 1986, Pacing and clinical electrophysiology : PACE.

[15]  S. Vlay.  The automatic internal cardioverter-defibrillator: comprehensive clinical follow-up, economic and social impact--the Stony Brook experience. , 1986, American heart journal.

[16]  R. Winkle,et al.  Implantation of the Automatic Implantable Cardioverter Defibrillator (AICD): Practical Aspects , 1986, Pacing and clinical electrophysiology : PACE.

[17]  P R Reid,et al.  Clinical evaluation of the internal automatic cardioverter-defibrillator in survivors of sudden cardiac death. , 1983, The American journal of cardiology.

[18]  L. Horowitz,et al.  Ventricular resection guided by epicardial and endocardial mapping for treatment of recurrent ventricular tachycardia. , 1980, The New England journal of medicine.

[19]  P. D. Chapman,et al.  The implanted defibrillator: relation of defibrillating lead configuration and clinical variables to defibrillation threshold. , 1985, Journal of the American College of Cardiology.

[20]  J. Fisher,et al.  Unipolar pacer artifacts induced failure of an automatic implantable cardioverter/defibrillator to detect ventricular fibrillation. , 1986, The American journal of cardiology.

[21]  R. Winkle,et al.  Determinants of survival in patients with ventricular tachyarrhythmias. , 1983, The New England journal of medicine.

[22]  E. Prystowsky,et al.  The implantable transvenous cardioverter: long-term efficacy and reproducible induction of ventricular tachycardia. , 1986, Circulation.

[23]  R. Winkle,et al.  Management of Patients with the Automatic Implantable Cardioverter/Defibrillator , 1985 .