title: Treatment of malignant ventricular arrhythmias with the automatic implantable cardioverter defibrillator.
abstract: Twenty-eight patients with malignant ventricular arrhythmias were treated with the automatic implantable cardioverter-defibrillator (AICD) in a 14-month period. Thirteen patients were resuscitated from a ventricular fibrillation (VF) episode. Fifteen patients presented with ventricular tachycardia (VT) refractory to medical therapy. The etiology was coronary artery disease in 23 of 28 patients (82%), dilated cardiomyopathy in 2 of 28 patients (7%), sarcoidosis in 2 of 28 patients, and 1 patient in 28 had lupus erythmatosis. The mean left ventricular ejection fraction was 29%. A total of 27 of 28 patients (96%) patients had inducible ventricular tachycardia using programmed stimulation. The patients considered for AICD implant failed a mean of 3.6 antiarrhythmic drugs. Rate counting and defibrillating leads were inserted through a lateral thoracotomy in 17 patients and a mediansternotomy incision in 11 patients in conjunction with another cardiac procedure in 10 patients. The generators were positioned in a subcutaneous pocket beneath the left costal margin. There were no operative deaths. The mean follow-up was 6.7 months (range 1 to 14) with no VT/VF deaths in patients with defibrillators. The study demonstrated that AICD is an effective device for prevention of sudden cardiac death.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Kentucky.
authors.forename: A D
authors.initials: AD
authors.lastname: Slater
authors.forename: I
authors.initials: I
authors.lastname: Singer
authors.forename: C S
authors.initials: CS
authors.lastname: Stavens
authors.forename: C
authors.initials: C
authors.lastname: Zee-Cheng
authors.forename: B L
authors.initials: BL
authors.lastname: Ganzel
authors.forename: J
authors.initials: J
authors.lastname: Kupersmith
authors.forename: C
authors.initials: C
authors.lastname: Mavroudis
authors.forename: L A
authors.initials: LA
authors.lastname: Gray
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy*; D003327:Coronary Disease / Q000150:complications; D003645:Death, Sudden; D004554:Electric Countershock / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D013318:Stroke Volume