The Implantable Cardioverter-Defibrillator: Clinical Results (original) (raw)

1991, Pacing and Clinical Electrophysiology

PALATIANOS, G.M., ET AL.: The Implantable Cardioverter-Defibrillator: Clinical Results. To evaluate the effectiveness of the automatic implantable cardioverter-defibnllator (AICD), a 7-year experience, from 1983-1990, was revieived. A totai 0/ ^11 patients received an AICD device. Their ages ranged between 8 and 83 years. Mean age was 63.9 years. There were 91 men and 20 women. Eighty of the patients received the AICD following an out-of-hospital cardiac arrest, whiie 31 were suffering from intermittent symptomatic ventricular tachycardio. The underlying etiology in 97 patients (87%) was ischemic coronary artery disease, in 11 patients (10%} dilated cardiomyopathy, and in 3 patients (3%) idiopathic ventricuiar fibrillation. Mean ejection fraction was 33.2%. Implantation 0/ the AICD was performed via a left thoracotomy in 39 patients, median sternotomy in 49 patients and subxiphoidsubcostal approach in 23 patients. Jn-hospitai mortality occurred in one patient who suffered an acute myocardial infarction 4 hours postoperativeiy, Out-of-hospital mortality was observed in 19 patients. There were two arrhythmic deaths. EoUow-up was available for 107 patients. Mean follow-up was 33.1 months. Sixty-six patients (62%J had AICD shocks. The initial appropriate shocks occurred during the first postimplantation year in 91% of the patients. In 53 0/ the survivors, initial AICD shocks took place within 4.4 ± 4.7 months from implantation. Thirteen of the 20 patients who died had received appropriate AICD shocks. In these patients, the time between implantation and first shock was 2.7 ± 3.6 months whereas the time between implantation and death was 11.3 ± 10.3 months (NS). We conclude that the AICD is effective in converting ventricuiar tachyarrhythmias and prolongs survival. [PACE, Vol. 14, February, Part II 1991) sudden cardiac death, automatic impiantabie defibrillator Address for reprints: George M. Palatianos, M,D,. Division of Thoracic and Cardiovascular Surgery |R-114), P,0. Box 016960 Miami, VL 33101,