Continuing experience with the automatic implantable cardioverter defibrillator

The automatic implantable cardioverter defibrillator (AICD) is now used commonly in the management of malignant ventricular arrhythmias. Its use may obviate the need for antiarrhythmic drugs or endocardial resection. We reviewed our continuing experience with the AICD to determine its safety and efficacy. Since June 1987, 102 patients (mean age: 63 years) who survived out-of-hospital ventricular fibrillation or hemodynamically unstable ventricular tachycardia not associated with acute myocardial infarction underwent implantation of an AICD. There were three operative deaths and nine complications. Eighty-nine patients are alive. No patient has experienced sudden cardiac death. Forty-two patients (43%) have had 1 or more AICD discharges associated with symptoms of cardiac arrest. During AICD implantation, it appears preferable to configure lead placement by individual patient characteristics rather than by a rigid protocol. The relative safety and efficacy of the AICD support its use as an alternative to toxic medications or more dangerous endocardial resection in suboptimal candidates.