Showing papers on "Implantable cardioverter-defibrillator published in 1986"

The Automatic Implantable Cardioverter-Defibrillator: Efficacy, Complications, and Device Failures

Abstract: Twenty-six patients with refractory ventricular arrhythmias received the automatic implantable cardioverter-defibrillator. A patch lead only was placed during arrhythmia surgery in 7 other patients. During 13 +/- 6 (SD) months, the device discharged in 10 patients because of a sustained ventricular arrhythmia. No sudden deaths occurred. There were 31 complications in 17 patients, including postoperative refractory heart failure, coronary artery erosion, subclavian vein thrombosis, postoperative stroke after conversion of atrial fibrillation, atelectasis with pneumonia, symptomatic pleural effusions, and infection at the generator site. The cardioverter-defibrillator discharged in 9 asymptomatic patients, failed to terminate ventricular fibrillation during postoperative testing in 3 patients, and had premature battery failure in 4 patients. Tachycardia slowing during chronic amiodarone therapy and unipolar ventricular pacing during ventricular fibrillation precluded or delayed arrhythmia sensing. Thus, the cardioverter-defibrillator can be life saving, but its potential complications and interactions with antiarrhythmic drugs and pacemakers must be considered at patient selection.

Unipolar pacer artifacts induced failure of an automatic implantable cardioverter/defibrillator to detect ventricular fibrillation

Abstract: The automatic implantable cardioverter-defibrillator (AICD®)1–5 has been implanted in over 500 patients with life-threatening ventricular arrhythmias. For detection of ventricular tachycardia or fibrillation (VF), the sensing system of the standard AICD uses a combination of the rate of electric signals received by sensing leads, and a probability density function.1–3 Because of the nature of sensing system of the AICD, several kinds of interactions with temporary or permanent pacemakers have been described.4,6 We have observed another phenomenon: failure of an AICD to detect VF due to large electrical signals from a unipolar pacemaker.

Implantation of the Automatic Implantable Cardioverter Defibrillator (AICD): Practical Aspects

Abstract: Most patients who are resuscitated from an episode of sudden cardiac death or one of sustained ventricular tachycardia (VT) can now be treated using serial electrophysiologic testing as a guide to drug therapy. Recurrence rates are low if an antiarrhythmic regimen can be found which prevents induction of VT. Patients failing serial drug testing have a high recurrence rate (approximately 50%/year). Most clinicians now refer such patients for either experimental antiarrhythmic therapy or electrical intervention. The most promising of the electrical interventions (including tachycardia converting pacemakers and intraoperative mapping) has been the automatic implantable cardioverter defibrillator (AICD). Only recently has the AICD been released from investigative status by the Food and Drug Administration. It can be implanted safely and with favorable clinical outcome if the techniques of implantation are well understood and used often. The text incorporates the authors' experience in implanting nearly 200 devices and is intended as a practical guide to the use of the AICD.

Combination of antitachycardia pacemaker and automatic implantable cardioverter/defibrillator for ventricular tachycardia.

Abstract: Antitachycardia pacing for ventricular tachycardia (VT) is associated with the possibility of fibrillating the heart; on the other hand, (he frequency of VT and patient discomfort can limit treatment with the automatic implantable cardioverter/defibrillator (AICD). To contribute to the further deveJopment of a universal pacemaker, we evaluated the combined use of the anti-tachycardia pacemaker (“tachylog”) and the AICD in five patients with recurrent VT. In the automatic mode, the “tachylog” worked as a bipolar VVI pacemaker. For antitachycardia pacing, a burst of rapid ventricular pacing was delivered at about 80% of the cycle length. During a follow-up period of 5 ± 2 months (range, 3 to 8) two to 291 successful interventions of antitachycardia pacing were counted from diagnostic data which had been collected by the pulse generator during the course of treatment. When the antitachycardia pacemaker failed to terminate VT, the AICD was activated. In the individual case, between 0 and 41 discharges of the AICD were delivered. The high pulse energy of the AICD did not damage I/in antitachycardia pacemaker; no interference of the two devices was observed. Future antitachycardia systems should be more flexible with regard to detection and termination modes, combining antitachycardia pacing with back-up defibrillation.

Automatic Implantable Cardioverter/ Defibrillator (AICD) and Antitachycardia Pacemaker (Tachylog): Combined use in Ventricular Tachyarrhythmias

Abstract: UNLABELLED Antitachycardia pacing in ventricular tachyarrhythmias (VT) is associated with potential acceleration of VT; frequency of VT and discomfort of the patient (pt) can limit treatment with the AICD. We therefore evaluated the combined use of antitachycardia pacing and AICD in 6 of 14 patients (age 50-70, mean 60 years) with AICD implantation because of VT, which could be terminated by temporary overdrive pacing. With the interactive mode of the Tachylog, termination of VT by the pacemaker as well as by the AICD was assessed after implantation. In the automatic mode, the Tachylog functioned as a bipolar VVI device with antitachycardia burst stimulation: 2-5 stimuli, interval 260-300 ms, 1-2 interventions. During follow-up of 12 +/- 5 months, the Tachylog terminated VT reliably 20 to 327 times per patient. In three patients, burst stimulation accelerated VT, which was terminated then by the AICD discharge. CONCLUSION Drug resistant ventricular tachyarrhythmias can be terminated by the Tachylog pacemaker avoiding patients' discomfort. In case of acceleration, ventricular tachyarrhythmias can be controlled by the automatic implantable cardioverter/defibrillator. A universal pacemaker should combine antitachycardia pacing with back-up defibrillation mode.

The automatic implantable cardioverter-defibrillator: results, observations, and comments.

Abstract: The automatic implantable cardioverter-defibrillator (AICD) is a device of proven efficacy in life-threatening ventricular tachycardia and fibrillation. Initial experience with the AICD at the University of Miami consists of 21 patients with recurrent ventricular dysrhythmias for a total follow-up of 3-35 months (mean 19). There were two deaths in the series, one nonarrhythmic and one arrhythmic, at the fifth and tenth postoperative months respectively. There were five complications requiring reoperation in three patients. Pacemakers were required in four patients with the AICD and resulted in interesting observations. Our data concur with previously published reports of improved survival in selected patients.

Recent clinical experience with the automatic implantable cardioverter-defibrillator.

Abstract: The automatic implantable cardioverter-defibrillator is an electronic device designed to monitor the heart continuously, identify ventricular tachycardias and ventricular fibrillation, and terminate the life-threatening arrhythmias with an internal countershock. This device has been proved to be safe and effective, and its use has led to a significant decrease of arrhythmic mortality in the implantees.