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The Automatic Implantable Cardioverter-Defibrillator: Clinical Experience, Complications, and Follow-up in 25 Patients

The Automatic Implantable Cardioverter-Defibrillator: Clinical Experience, Complications, and... Abstract • 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. (Arch Intern Med 1988;142:70-76) References 1. Shale BT, Miles WM, Heger JJ, et al: Survivors of cardiac arrest: Prevention of recurrence by drug therapy as predicted by electrophysiologic testing or electrophysiologic monitoring. Am J Cardiol 1986;57:113-119.Crossref 2. Horowitz LN, Harken AH, Kaster JA, et al: Ventricular resection guided by epicardial mapping for the treatment of recurrent ventricular tachycardia. N Engl J Med 1980;302:591-593.Crossref 3. Garan H, Nguyen K, McGovern B, et al: Perioperative and long-term results with electrophysiologically directed ventricular surgery for recurrent ventricular tachycardia. J Am Coll Cardiol 1986;8:201-209.Crossref 4. Evans GT, Scheinman MM, and the Executive Committee of the Percutaneous Cardiac Mapping and Ablation Registry: Catheter ablation for control of ventricular tachycardia: A report of the Percutaneous Cardiac Mapping and Ablation Registry. Pace 1986;9:1391-1395.Crossref 5. Fischer JD, Johnson DR, Kim SG, et al: Implantable pacers for tachycardia termination: Stimulation techiques and long-term efficacy. Pace 1986;9:1325-1333.Crossref 6. Mirowski M, Mower MM, Reid PR: Management of sustained ventricular tachycardia. J Am Coll Cardiol 1985;6:213-214.Crossref 7. Miles WM, Prystowsky EN, Heger JJ, et al: The implantable transvenous cardioverter: Long-term efficacy and reproducible induction of ventricular tachycardia. Circulation 1986;74:518-524.Crossref 8. Mirowski M, Mower MM, Reid PR: The automatic implantable defibrillator. Am Heart J 1980;100:1089-1092.Crossref 9. Mirowski M, Reid PR, Winkle RA, et al: Mortality in patients with implanted automatic defibrillators. Ann Intern Med 1983;98:585-588.Crossref 10. Mirowski M: Management of malignant ventricular arrhythmias with automatic planted cardioverter-defibrillators. Mod Cone Cardiovasc Dis 1983;52:41-53. 11. Reid PR, Mirowski M, Mower MM, et al: Clinical evaluation of the internal automatic cardioverter-defibrillator in survivors of sudden cardiac death. Am J Cardiol 1983;51:1608-1613.Crossref 12. Echt DS, Armstrong K, Schmidt P, et al: Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator. Circulation 1985;71:289-296.Crossref 13. Veltri EP, Mower MM, Quarnieri T, et al: Clinical efficacy of the automatic implantable defibrillator: Six-year cumulative experience. Circulation 1986;74( (suppl 2) ):109.Crossref 14. Luceri RM, Thurer RJ, Palatianos GM, et al: The automatic implantable cardioverter-defibrillator: Results, observations, and comments. Pace 1986;9:1343-1348.Crossref 15. Marchlinski FE, Flores BT, Buxton AE, et al: The automatic implantable cardioverter-defibrillator: Efficacy, complications, and device failures. Ann Intern Med 1986;104:481-488.Crossref 16. Vlay SC: The automatic internal cardioverter-defibrillator: Comprehensive clinical follow-up, economic and social impact: The Stony Brook experience. Am Heart J 1986;112:189-194.Crossref 17. Echt DS, Winkle RA: Management of patients with the automatic implantable cardioverter/defibrillator. Clin Prog Electrophysiol Pacing 1985;3:4-16.Crossref 18. Cannom DS, Winkle RA: Implantation of the automatic implantable cardioverter defibrillator (AICD): Practical aspects. Pace 1986;9:793-809.Crossref 19. Chapman PD: Patient selection and preoperative evaluation for the implanted defibrillator. Clin Prog Electrophysiol Pacing 1986;4:255-259. 20. Troup PJ: Lead system selection, implantation, and testing for the automatic implantable cardioverter-defibrillator. Clin Prog Electrophysiol Pacing 1986;4:260-276. 21. Brodman R, Furman S, Waspe LE, et al: Surgical techniques for implantation of the automatic implantable cardioverter defibrillator. Clin Prog Electrophysiol Pacing 1986;4:292-305. 22. Morowski M, Reid PR, Mower MM, et al: Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980;303:322-324.Crossref 23. Watkins L, Guarnieri T, Griffith LSC, et al: Implantation of the automatic defibrillator: Current surgical techniques. Clin Prog Electrophysiol Pacing 1986;4:286-291. 24. Swerdlow CD, Winkle RA, Mason JW: Determinants of survival in patients with ventricular tachyarrhythmias. N Engl J Med 1983;308:1436-1442.Crossref 25. Lawrie GM, Wright-Hargis J, Lin HT, et al: Epicardial implantation of the automatic implantable cardioverter-defibrillator by left subcostal thoracotomy. Clin Prog Electrophysiol Pacing 1986;4:277-285. 26. Mirowski M, Reid PR, Mower MM, et al: Clinical performance of the implantable cardioverter-defibrillator. Pace 1984;70:1345-1350.Crossref 27. Chapman PD, Troup PJ: The automatic implantable cardioverter-defibrillator: Evaluating suspected inappropriate shocks. J Am Coll Cardiol 1986;7:1075-1078.Crossref 28. Kim SG, Furman S, Waspe LE, et al: Unipolar pacer artifacts induced failure of an automatic implantable cardioverter/defibrillator to detect ventricular fibrillation. Am J Cardiol 1986;57:880-881.Crossref 29. Troup PJ, Chapman PD, Olinger GN, et al: The implanted defibrillator: Relation of defibrillating lead configuration and clinical variables to defibrillation threshold. J Am Coll Cardiol 1985;6:1315-1321.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Automatic Implantable Cardioverter-Defibrillator: Clinical Experience, Complications, and Follow-up in 25 Patients

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380010074007
Publisher site
See Article on Publisher Site

Abstract

Abstract • 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. (Arch Intern Med 1988;142:70-76) References 1. Shale BT, Miles WM, Heger JJ, et al: Survivors of cardiac arrest: Prevention of recurrence by drug therapy as predicted by electrophysiologic testing or electrophysiologic monitoring. Am J Cardiol 1986;57:113-119.Crossref 2. Horowitz LN, Harken AH, Kaster JA, et al: Ventricular resection guided by epicardial mapping for the treatment of recurrent ventricular tachycardia. N Engl J Med 1980;302:591-593.Crossref 3. Garan H, Nguyen K, McGovern B, et al: Perioperative and long-term results with electrophysiologically directed ventricular surgery for recurrent ventricular tachycardia. J Am Coll Cardiol 1986;8:201-209.Crossref 4. Evans GT, Scheinman MM, and the Executive Committee of the Percutaneous Cardiac Mapping and Ablation Registry: Catheter ablation for control of ventricular tachycardia: A report of the Percutaneous Cardiac Mapping and Ablation Registry. Pace 1986;9:1391-1395.Crossref 5. Fischer JD, Johnson DR, Kim SG, et al: Implantable pacers for tachycardia termination: Stimulation techiques and long-term efficacy. Pace 1986;9:1325-1333.Crossref 6. Mirowski M, Mower MM, Reid PR: Management of sustained ventricular tachycardia. J Am Coll Cardiol 1985;6:213-214.Crossref 7. Miles WM, Prystowsky EN, Heger JJ, et al: The implantable transvenous cardioverter: Long-term efficacy and reproducible induction of ventricular tachycardia. Circulation 1986;74:518-524.Crossref 8. Mirowski M, Mower MM, Reid PR: The automatic implantable defibrillator. Am Heart J 1980;100:1089-1092.Crossref 9. Mirowski M, Reid PR, Winkle RA, et al: Mortality in patients with implanted automatic defibrillators. Ann Intern Med 1983;98:585-588.Crossref 10. Mirowski M: Management of malignant ventricular arrhythmias with automatic planted cardioverter-defibrillators. Mod Cone Cardiovasc Dis 1983;52:41-53. 11. Reid PR, Mirowski M, Mower MM, et al: Clinical evaluation of the internal automatic cardioverter-defibrillator in survivors of sudden cardiac death. Am J Cardiol 1983;51:1608-1613.Crossref 12. Echt DS, Armstrong K, Schmidt P, et al: Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator. Circulation 1985;71:289-296.Crossref 13. Veltri EP, Mower MM, Quarnieri T, et al: Clinical efficacy of the automatic implantable defibrillator: Six-year cumulative experience. Circulation 1986;74( (suppl 2) ):109.Crossref 14. Luceri RM, Thurer RJ, Palatianos GM, et al: The automatic implantable cardioverter-defibrillator: Results, observations, and comments. Pace 1986;9:1343-1348.Crossref 15. Marchlinski FE, Flores BT, Buxton AE, et al: The automatic implantable cardioverter-defibrillator: Efficacy, complications, and device failures. Ann Intern Med 1986;104:481-488.Crossref 16. Vlay SC: The automatic internal cardioverter-defibrillator: Comprehensive clinical follow-up, economic and social impact: The Stony Brook experience. Am Heart J 1986;112:189-194.Crossref 17. Echt DS, Winkle RA: Management of patients with the automatic implantable cardioverter/defibrillator. Clin Prog Electrophysiol Pacing 1985;3:4-16.Crossref 18. Cannom DS, Winkle RA: Implantation of the automatic implantable cardioverter defibrillator (AICD): Practical aspects. Pace 1986;9:793-809.Crossref 19. Chapman PD: Patient selection and preoperative evaluation for the implanted defibrillator. Clin Prog Electrophysiol Pacing 1986;4:255-259. 20. Troup PJ: Lead system selection, implantation, and testing for the automatic implantable cardioverter-defibrillator. Clin Prog Electrophysiol Pacing 1986;4:260-276. 21. Brodman R, Furman S, Waspe LE, et al: Surgical techniques for implantation of the automatic implantable cardioverter defibrillator. Clin Prog Electrophysiol Pacing 1986;4:292-305. 22. Morowski M, Reid PR, Mower MM, et al: Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980;303:322-324.Crossref 23. Watkins L, Guarnieri T, Griffith LSC, et al: Implantation of the automatic defibrillator: Current surgical techniques. Clin Prog Electrophysiol Pacing 1986;4:286-291. 24. Swerdlow CD, Winkle RA, Mason JW: Determinants of survival in patients with ventricular tachyarrhythmias. N Engl J Med 1983;308:1436-1442.Crossref 25. Lawrie GM, Wright-Hargis J, Lin HT, et al: Epicardial implantation of the automatic implantable cardioverter-defibrillator by left subcostal thoracotomy. Clin Prog Electrophysiol Pacing 1986;4:277-285. 26. Mirowski M, Reid PR, Mower MM, et al: Clinical performance of the implantable cardioverter-defibrillator. Pace 1984;70:1345-1350.Crossref 27. Chapman PD, Troup PJ: The automatic implantable cardioverter-defibrillator: Evaluating suspected inappropriate shocks. J Am Coll Cardiol 1986;7:1075-1078.Crossref 28. Kim SG, Furman S, Waspe LE, et al: Unipolar pacer artifacts induced failure of an automatic implantable cardioverter/defibrillator to detect ventricular fibrillation. Am J Cardiol 1986;57:880-881.Crossref 29. Troup PJ, Chapman PD, Olinger GN, et al: The implanted defibrillator: Relation of defibrillating lead configuration and clinical variables to defibrillation threshold. J Am Coll Cardiol 1985;6:1315-1321.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1988

References

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