[Implantation of an internal defibrillator]

The article, part one of two in this issue, enables the nurse to follow a patient who receives an implantable defibrillator after surviving sudden cardiac death. Sudden cardiac death, which claims approximately 400,000 lives annually in the United States, is defined as natural, unexpected death due to cardiac causes, preceded by abrupt loss of consciousness within one hour of the onset of acute symptoms. It is generally caused by a complex interaction between a functional heart abnormality (such as ischemia) and an anatomic substrate (such as the myocardial scar tissue). Ventricular dysrrhythmias account for the majority of sudden cardiac deaths. This condition is treated with pharmaceutical antiarrhythmic agents or by implanting an internal cardioverter defibrillator. The equipment and surgery using the transvenous approach are described here. Specific nursing care during the postoperative period is also explained. Finally, the authors present several recommendations related to the convalescent period at home.