title: The automatic implantable cardioverter-defibrillator. Long-term clinical experience and outcome at a hospital without an open-heart surgery program.
abstract: From November 1982 through April 1989, 111 patients with refractory sustained ventricular tachycardia/fibrillation had the automatic cardioverter-defibrillator implanted at our institution, the first community hospital involved in implantation of such a device. We have reviewed our long-term clinical experience to assess the feasibility, learning curve, and efficacy of device implantation in a facility with cardiac electrophysiology expertise but without open-heart surgery facilities. All patients were considered inoperable or at high risk for other concomitant surgery. Eighty-six patients (77%) underwent uneventful implantation. Nine patients (8%) died prior to hospital discharge. Operative mortality declined from 10.9% to 5.4% during the first half (55 patients; November 1982 through September 1986) and second half (56 patients; October 1986 through April 1989) of the experience. Other postoperative complications occurred in 16 patients (14%), 12 of whom experienced complications during the first half of the experience. At 22 +/- 20 (mean +/- SD) months' follow-up, 78 (76%) of 102 patients discharged were alive, and 24 patients (24%) had died. Fifty patients (49%) had experienced at least one automatic cardioverter-defibrillator discharge associated with hypotensive symptoms. The actuarial incidence of sudden death at 1, 2, and 3 years was 1.2%, 5.5%, and 6.2%, respectively. We concluded that the automatic implantable cardioverter-defibrillator is an effective therapy for refractory ventricular tachycardia/fibrillation and that device implantation at community hospitals with an experienced cardiac electrophysiology team is both feasible and practical.
authors.affiliation: Department of Medicine, Sinai Hospital of Baltimore, MD 21215.
authors.forename: T J
authors.initials: TJ
authors.lastname: Cohen
authors.forename: P R
authors.initials: PR
authors.lastname: Reid
authors.forename: M M
authors.initials: MM
authors.lastname: Mower
authors.forename: M
authors.initials: M
authors.lastname: Mirowski
authors.forename: D
authors.initials: D
authors.lastname: Aarons
authors.forename: J
authors.initials: J
authors.lastname: Juanteguy
authors.forename: E P
authors.initials: EP
authors.lastname: Veltri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore; D003645:Death, Sudden / Q000453:epidemiology; D004554:Electric Countershock / Q000009:adverse effects / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006745:Hospital Bed Capacity, 300 to 499; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D019736:Prostheses and Implants / Q000009:adverse effects / Q000706:statistics & numerical data*; D012008:Recurrence; D015996:Survival Rate; D013610:Tachycardia / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000628:therapy*