Related Experiment Videos
Automatic implantable cardioverter-defibrillator: early experience at Wilford Hall USAF Medical Center
1Section of Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236-5300.
Insights
The automatic implantable cardioverter-defibrillator (AICD) effectively treated malignant ventricular arrhythmias in 15 patients. This device demonstrated a low risk and high efficacy in managing life-threatening heart rhythm disorders.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Malignant ventricular arrhythmias pose a significant threat to patient survival.
- The automatic implantable cardioverter-defibrillator (AICD) is a critical intervention for managing these conditions.
Purpose of the Study:
- To evaluate the efficacy and safety of the AICD in patients with malignant ventricular arrhythmias.
- To assess the outcomes of AICD implantation in a cohort of patients with diverse cardiac etiologies.
Main Methods:
- A prospective study involving 15 patients with malignant ventricular arrhythmias.
- AICD implantation via thoracotomy or sternotomy, with generator placement in a subcutaneous pocket.
- Programmed electrical stimulation was used to induce ventricular tachycardia in 14 patients.
Main Results:
- The primary cause of arrhythmias was coronary artery disease (87%).
- Mean ejection fraction was 29%, indicating significant cardiac dysfunction.
- One early and one late death occurred, both due to congestive heart failure, with the AICD functioning properly.
- Five patients received a total of 17 shocks, indicating appropriate device function.
Conclusions:
- The AICD is a highly effective treatment for malignant ventricular tachyarrhythmias.
- The AICD presents a low-risk therapeutic option for patients with life-threatening arrhythmias.
- Device function remained optimal even in patients who succumbed to non-arrhythmic causes.
Abstract:
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.