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Implantation of the automatic implantable cardioverter defibrillator (AICD): practical aspects
Insights
Patients resuscitated from sudden cardiac death or ventricular tachycardia (VT) can be treated with electrophysiologic testing. The automatic implantable cardioverter defibrillator (AICD) offers a promising electrical intervention for those unresponsive to drug therapy.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Sudden cardiac death and sustained ventricular tachycardia (VT) pose significant risks.
- Serial electrophysiologic testing guides antiarrhythmic drug therapy for many patients.
- Patients unresponsive to drug therapy have high recurrence rates.
Purpose of the Study:
- To provide a practical guide to the use of the automatic implantable cardioverter defibrillator (AICD).
- To detail the safe implantation techniques and favorable clinical outcomes associated with the AICD.
- To highlight the AICD as a promising electrical intervention for refractory VT.
Main Methods:
- Review of authors' experience implanting nearly 200 AICD devices.
- Discussion of electrophysiologic testing protocols for guiding therapy.
- Emphasis on understanding and applying AICD implantation techniques.
Main Results:
- Antiarrhythmic drug therapy guided by electrophysiologic testing is effective in preventing VT recurrence for many patients.
- Patients failing drug therapy have a high annual recurrence rate (~50%).
- The AICD has recently been released from investigative status, demonstrating safe implantation and favorable outcomes.
Conclusions:
- The AICD represents a key electrical intervention for patients with refractory VT.
- Proper understanding and frequent application of implantation techniques are crucial for successful AICD use.
- The AICD offers a viable treatment option for patients with recurrent VT unresponsive to antiarrhythmic drugs.
Abstract:
Most patients who are resuscitated from an episode of sudden cardiac death or one of sustained ventricular tachycardia (VT) can now be treated using serial electrophysiologic testing as a guide to drug therapy. Recurrence rates are low if an antiarrhythmic regimen can be found which prevents induction of VT. Patients failing serial drug testing have a high recurrence rate (approximately 50%/year). Most clinicians now refer such patients for either experimental antiarrhythmic therapy or electrical intervention. The most promising of the electrical interventions (including tachycardia converting pacemakers and intraoperative mapping) has been the automatic implantable cardioverter defibrillator (AICD). Only recently has the AICD been released from investigative status by the Food and Drug Administration. It can be implanted safely and with favorable clinical outcome if the techniques of implantation are well understood and used often. The text incorporates the authors' experience in implanting nearly 200 devices and is intended as a practical guide to the use of the AICD.