Automatic implantable cardioverter-defibrillator: early experience at Wilford Hall USAF Medical Center.
Fifteen patients with malignant ventricular arrhythmias were treated with the automatic implantable cardioverter-defibrillator (AICD) over a 22-month period. The cause of the arrhythmia was coronary artery disease in 13 of the patients (87%), sarcoid cardiomyopathy in one (7%), and a primary electrical abnormality in one (7%). The mean ejection fraction was 29%, with a range of 15% to 70%. Fourteen of the patients had inducible ventricular tachycardia using program stimulation. Defibrillating and rate-sensing leads were inserted through a lateral thoracotomy in 13 patients and through a median sternotomy in two patients in conjunction with other cardiac procedures. The generators were positioned in a subcutaneous pocket beneath the left costal cartilage. There was one early and one late death, both due to congestive heart failure. Neither was related to a ventricular tachyarrhythmia, and in each patient the AICD was functioning properly at the time of death. The mean follow-up period was 11.5 months, with five patients receiving a total of 17 shocks. We conclude that the AICD is a highly effective, low-risk treatment for malignant ventricular tachyarrhythmias.
Watson
J
J
Section of Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236-5300.
Smith
V
V
Schmidt
D
D
Navratil
D
D
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D000075202:Contraindications; D004554:Electric Countershock / Q000295:instrumentation*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D013610:Tachycardia / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D013781:Texas / Q000453:epidemiology