Operative mortality with implantation of the automatic cardioverter-defibrillator.
Operative mortality was studied in 939 consecutive patients undergoing initial implantation of an automatic implantable cardioverter-defibrillator (AICD) at 15 hospitals. Twenty-nine (3.1%) patients died during the first 30 days after surgery. Among patients who survived beyond the first 30 postoperative days, ejection fraction data were available in 219; compared with the mortality group, these survivors had a significantly higher ejection fraction (34 +/- 15 vs 26 +/- 10%, respectively, p less than 0.001), despite similar age, sex, underlying heart disease, type of presenting arrhythmia and prevalence of concomitant surgery. The causes of perioperative death were sudden in 7 (24%), tachyarrhythmic/nonsudden in 5 (17%), cardiac nonarrhythmic in 9 (31%), and noncardiac in 8 (28%). Twenty-four (83%) of the deaths occurred before hospital discharge, and in all 9 instances of in-hospital sudden and tachyarrhythmic/nonsudden death, the initial recorded rhythm was sustained ventricular tachycardia or fibrillation; in 5 (56%) of these 9 patients the AICD had been in a deactivated state since implantation. Other possible contributory factors in the 12 sudden or tachyarrhythmic/nonsudden deaths included acute myocardial ischemia or infarction in 2 (17%), and "device proarrhythmia" in 3 (25%) that were AICD-related in 2 and secondary to an antitachycardia pacemaker in another; defibrillation threshold testing was not performed in 3 patients (1 of whom had terminal ventricular fibrillation). Thus, in this multicenter experience with thoracotomy requiring AICD implantation, operative (30-day) mortality was 3.1% and correlated inversely with left ventricular ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)
Mosteller
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RD
Division of Cardiology, Harper Hospital/Detroit Medical Center, Detroit, Michigan 48201.
Lehmann
M H
MH
Thomas
A C
AC
Jackson
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K
D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013610:Tachycardia / Q000401:mortality; D013908:Thoracotomy / Q000401:mortality*; D014693:Ventricular Fibrillation / Q000401:mortality; D016277:Ventricular Function, Left / Q000502:physiology