Related Experiment Videos
Clinical experience in seventy-seven patients with the automatic implantable cardioverter defibrillator
A S Manolis1, W Tan-DeGuzman, M A Lee
1Department of Medicine, Tufts University School of Medicine, Boston, MA 02111.
Insights
Automatic cardioverter defibrillator (AICD) implantation effectively treated drug-refractory ventricular tachycardia (VT) and ventricular fibrillation (VF) in 77 patients. AICD implantation showed a low operative mortality and reduced arrhythmia recurrence during follow-up.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Drug-refractory sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) pose significant risks.
- Conventional antiarrhythmic drug therapy often fails to control these life-threatening arrhythmias.
- Automatic cardioverter defibrillators (AICDs) are a critical therapeutic option for patients with intractable ventricular arrhythmias.
Purpose of the Study:
- To evaluate the safety and efficacy of AICD implantation in patients with drug-refractory VT/VF.
- To assess the outcomes of AICD implantation in a cohort of patients with diverse underlying cardiac conditions.
- To determine the impact of AICD implantation on arrhythmia recurrence and patient survival.
Main Methods:
- Seventy-seven patients with drug-refractory VT/VF underwent AICD implantation.
- Patients had a mean age of 60 years, with coronary artery disease being the most common underlying condition (60 patients).
- Electrophysiologic testing was performed to assess inducibility of VT/VF, and concomitant cardiac surgeries were noted.
Main Results:
- AICD implantation resulted in a low operative mortality of 2.6% (2 deaths).
- Eighty-three percent of patients had inducible VT/VF at baseline, which was managed by AICD.
- During a mean follow-up of 15 months, six patients died from various causes, including probable pulse generator failure, myocardial infarction, heart failure, and respiratory failure.
Conclusions:
- AICD implantation is a safe and effective treatment for patients with drug-refractory VT/VF.
- The procedure demonstrated a low operative mortality and managed inducible arrhythmias effectively.
- While AICD implantation reduces arrhythmia recurrence, long-term survival is influenced by underlying cardiac conditions and device function.
Abstract:
Seventy-seven patients with drug-refractory sustained ventricular tachycardia (VT) (28 patients) or ventricular fibrillation (VF) (49 patients) underwent implantation of an automatic cardioverter defibrillator (AICD). The 67 men and 10 women, with a mean age of 60 +/- 12 years (range 18 to 79), had coronary artery disease (60 patients), idiopathic cardiomyopathy (eight patients), mitral valve prolapse (four patients), hypertensive heart disease (one patient), Ebstein's anomaly (one patient), long QT syndrome (one patient), and primary electrical disease (two patients). The mean left ventricular ejection fraction was 35 +/- 16% (range 10% to 75%). Sustained VT/VF was induced in 64 patients (83%) at baseline electrophysiologic testing. A mean of 4.1 +/- 1.3 antiarrhythmic drugs failed to control the arrhythmia. Associated surgery at AICD implantation included coronary artery bypass in 19 patients, coronary bypass with aneurysmectomy in six patients, and aneurysmectomy alone in one patient. Five patients had only prophylactic patches implanted during aneurysmectomy or coronary bypass and the AICD device was subsequently implanted under local anesthesia to prevent arrhythmia recurrence or to control persistently inducible VT. Operative mortality was 2.6% with two deaths from intractable VF. Fifty-two patients (69%) continued receiving antiarrhythmic drugs to suppress spontaneous VT. During a mean follow-up of 15 +/- 13 months (range 1 to 63), six patients died: two suddenly due to probable pulse generator failure (greater than 2 years old), one of acute myocardial infarction, two of heart failure, and one of respiratory failure.(ABSTRACT TRUNCATED AT 250 WORDS)