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Related Experiment Videos

Early experience with an implantable cardioverter.

D P Zipes, J J Heger, W M Miles

    The New England Journal of Medicine
    |August 23, 1984
    PubMed
    Summary

    This study shows that an implantable cardioverter can terminate ventricular tachycardia. However, automatic mode use requires caution due to potential arrhythmia misidentification and adverse events.

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    Area of Science:

    • Cardiology
    • Medical Devices
    • Electrophysiology

    Background:

    • Sustained ventricular tachycardia (VT) is a life-threatening arrhythmia.
    • Current treatments for VT include antiarrhythmic drugs and external defibrillation.
    • There is a need for minimally invasive and programmable devices for VT management.

    Purpose of the Study:

    • To evaluate the efficacy and safety of a novel, fully programmable, implantable cardioverter for terminating sustained ventricular tachycardia.
    • To assess the feasibility of transvenous implantation and patient tolerance of the device.

    Main Methods:

    • Seven patients with sustained VT received transvenous implantation of a 95g programmable cardioverter under local anesthesia.
    • The device delivered cardioversion shocks on command or automatically, and also functioned as a demand ventricular pacemaker.

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  • Programmed ventricular stimulation and overdrive pacing capabilities were utilized.

    • Main Results:

    • Cardioversion of VT was achieved with low energy (<0.5 J mean) and was well tolerated by awake patients.
    • In one case, automatic mode activation led to misidentification of atrial fibrillation, triggering additional shocks.
    • A shock during the ST segment induced ventricular fibrillation, successfully treated with external defibrillation.

    Conclusions:

    • Implantable catheter-based cardioversion for sustained VT is feasible.
    • Current automatic mode functionality requires cautious and selective application due to arrhythmia differentiation challenges.
    • Advantages include small size, ease of implantation, and pacing capabilities; future devices need defibrillation and improved arrhythmia discrimination.