This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Yee, E. S. Search for Related Content PubMed Articles by Yee, E. S. Social Bookmarking                         What's this?

Automatic Implantable Cardioverter Defibrillators: Surgical Approaches for Optimal Function

Division of Cardiovascular Thoracic Surgery, East Tennessee State University, Johnson City, Tennessee, University of California, San Francisco, California

The automatic implantable car dioverter defibrillator (AICD) has significantly enhanced the treatment of malignant tachyarrhythmia but has complex requirements for contin uous function. Forty-nine patients (pts, ages nine to seventy-nine) from 377 pts studied for life-threatening tachyarrhythmias (13%) underwent AICD hardware placement during the first forty-eight months of clinical investigation. Access was dictated by (1) prior operative procedures (17 pts), (2) adequate sensing thresholds (12 pts), and (3) low thresholds (ie, s 15 watts) for successful defibrilla tion configuration (21 pts). Late com plications and morbidity (26 pts, 53%) have been the rule, the most common due to: (A) generator fail ures (15 pts), (B) patches or lead mal positions (4 pts), (C) inappropriate sensing from lead failures (3 pts), and (D) required explanations (leads only for 2 pts and units for 2 pts). There has been only 1 operative death among the 49 pts and none for the 21 revisions and generator changes (overall 1/70 procedures, 1.4%). However, survivals at one, two, and three years were 82%, 56%, and 40% respectively with the majority of late deaths attributed to congestive heart failure (CHF).

In summary, (1) AICD morbidity remains frequent but can be mini mized. Incidental placement should be avoided owing to associated mor bidity (explantation). (2) Optimal configurations usually require (a) ep icardial access, (b) patches directed at the ventricular focus for lower de fibrillation thresholds, (c) generator implantation adjusted for habitus, growth in children, and frequent generator failure. (3) Long-term sur vival has been poor in patients with associated CHF.

Vascular and Endovascular Surgery, Vol. 23, No. 6, 458-463 (1989)
DOI: 10.1177/153857448902300607


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?