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[Long-term clinical results of the implantable automatic defibrillator]
Insights
Automatic implantable cardioverter-defibrillators (AICD) effectively treat sudden cardiac death from ventricular arrhythmias. Simplified implantation techniques reduced complications, showing AICD reliability in palliative care.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Context:
- Sudden cardiac death (SCD) due to ventricular arrhythmias remains a significant clinical challenge.
- Early automatic implantable cardioverter-defibrillator (AICD) devices presented implantation and efficacy challenges.
- Evaluating the safety and effectiveness of the AID-B device in a patient cohort.
Purpose:
- To assess the implantation outcomes, defibrillation efficacy, and complication rates of the AID-B device.
- To evaluate the long-term performance and reliability of the AID-B for ventricular arrhythmias.
- To determine the palliative treatment potential of the AID-B in patients at risk for sudden cardiac death.
Summary:
- Twelve patients received the AID-B between 1982 and 1986 for various arrhythmias.
- Implantation techniques evolved from thoracic to subcostal approaches, reducing local complications.
- Defibrillation thresholds were lower with the 2-patch electrode system compared to the combined patch and endocavitary electrode.
- The AID-B demonstrated reliability, with no inappropriate activations during follow-up, and effectively managed documented arrhythmias.
Impact:
- Simplified implantation techniques improved device tolerance and reduced complications.
- The AID-B proved to be a reliable and effective palliative treatment for preventing sudden death.
- The study highlights the importance of device maintenance and replacement for sustained efficacy.
Abstract:
Between October 1982 and May 1986, 12 patients were implanted with an automatic defibrillator AID-B; 7 had coronary artery disease, 2 had dilated cardiomyopathies and 3 had torsades de pointe with or without long QT intervals. Five patients had a thoracic approach with a left ventricular patch and implantation of a right atrial endocavitary electrode. Thereafter a subcostal approach was used with 2 patch electrodes. Two of the first 5 patients rejected the device, but this complication was not observed in the remaining 7 cases. The threshold of defibrillation was greater than 25 joules in 1 case out of 5 with a patch and endocavitary electrode. This threshold was less than 25 joules in all patients with 2 patch electrodes. The AID-B was triggered in less than 20 seconds. One patient died of pulmonary embolism 8 days after implantation; 2 others had a temporary aggravation of their arrhythmias. There were no cases of inappropriate activation of the AID-B device during follow up: 5 patients had no arrhythmia or defibrillation. The 6 others had 2 to 35 defibrillations with documented arrhythmias before or after defibrillation. One patient suffered a sudden death after exhaustion of the device which had functioned on two occasions but had not been replaced for economic reasons. The technique of implantation has been simplified, so limiting local complications. This device is reliable and represents an effective palliative treatment of sudden death due to ventricular arrhythmias.