THE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR - CLINICAL-RESULTS

To evaluate the effectiveness of the automatic implantable cardioverter-defibrillator (AICD), a 7-year experience, from 1983-1990, was reviewed. A total of 111 patients received an AICD device. Their ages ranged between 8 and 83 years. Mean age was 63.9 years. There were 91 men and 20 women. Eighty of the patients received the AICD following an out-of-hospital cardiac arrest, while 31 were suffering from intermittent symptomatic ventricular tachycardia. The underlying etiology in 97 patients (87%) was ischemic coronary artery disease, in 11 patients (10%) dilated cardiomyopathy, and in 3 patients (3%) idiopathic ventricular fibrillation. Mean ejection fraction was 33.2%. Implantation of the AICD was performed via a left thoracotomy in 39 patients, median sternotomy in 49 patients and subxiphoid-subcostal approach in 23 patients. In-hospital mortality occurred in one patient who suffered an acute myocardial infarction 4 hours postoperatively. Out-of-hospital mortality was observed in 19 patients. There were two arrhythmic deaths. Follow-up was available for 107 patients. Mean follow-up was 33.1 months. Sixty-six patients (62%) had AICD shocks. The initial appropriate shocks occurred during the first postimplantation year in 91% of the patients. In 53 of the survivors, initial AICD shocks took place within 4.4 +/- 4.7 months from implantation. Thirteen of the 20 patients who died had received appropriate AICD shocks. In these patients, the time between implantation and first shock was 2.7 +/- 3.6 months whereas the time between implantation and death was 11.3 +/- 10.3 months (NS). We conclude that the AICD is effective in converting ventricular tachyarrhythmias and prolongs survival.