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Automatic defibrillation in man: is it feasible?

L Watkins, P R Reid, E V Platia

    American Journal of Surgery
    |June 1, 1983
    PubMed
    Summary
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    Automatic defibrillation implantation is feasible in patients with life-threatening ventricular arrhythmias. This therapy appears to improve survival rates in carefully selected high-risk individuals.

    Area of Science:

    • Cardiology
    • Medical Devices
    • Electrophysiology

    Background:

    • Sudden cardiac arrest due to malignant ventricular tachyarrhythmias poses a significant mortality risk.
    • Medical therapy for refractory arrhythmias has limitations, necessitating alternative treatment strategies.

    Purpose of the Study:

    • To evaluate the feasibility and efficacy of automatic defibrillator implantation in patients with recurrent, drug-refractory cardiac arrest.
    • To assess the impact of automatic defibrillation on survival in a high-risk patient cohort.

    Main Methods:

    • Twenty-eight patients with refractory ventricular arrhythmias underwent automatic defibrillator implantation via lateral thoracotomy or subxiphoid approaches.
    • No operative mortality or significant surgical complications were observed.

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  • Follow-up averaged 14 months (up to 29 months), with device performance and patient survival monitored.

    • Main Results:

    • The implanted automatic defibrillators successfully identified and reverted 50 episodes of ventricular tachyarrhythmias in hospitalized patients.
    • Eight patients experienced 20 out-of-hospital resuscitations, with the device automatically delivering therapy.
    • Kaplan-Meier survival analysis indicated an actual 1-year mortality of 30%, significantly lower than the projected 60% without defibrillation.

    Conclusions:

    • Automatic defibrillation is a technically feasible and safe therapeutic option for selected patients with life-threatening ventricular arrhythmias.
    • Implantable automatic defibrillators demonstrate a potential to increase survival rates in high-risk cardiac arrest survivors.
    • Further research is warranted to optimize patient selection and long-term outcomes for automatic defibrillation therapy.