Clinical experience with the internal cardioverter/defibrillator

M. Zardini, C. Storti, A. Graffigna, C. Pappone, F. Lamberti, M. Di Pietro, M. Vigano, N. Spampinato, J. A. Salerno, M. Chiariello

Research output: Contribution to journalArticle

Abstract

We describe our experience with the implantable cardioverter/defibrillator (ICD) for treatment of patients (pts) with malignant ventricular arrhythmias refractory to other therapies. Over a 3 year period, 52 pts (47M, 5F, aged 24-70 years, mean ± SD 54 ± 12) underwent ICD implantation for ventricular tachycardia (32 pts), ventricular fibrillation (5 pts) or both arrhythmias (15 pts). Thirty-two pts had coronary artery disease, 13 pts had primary myocardial disease, 3 pts had other cardiac disease and 4 pts had primary electrical disease. Surgical approach was median sternotomy in 27 pts and left lateral thoracotomy in 18 pts. Seven pts underwent primary percutaneous endocavitary placement of defibrillating leads. In 1 pt an endocavitary lead was secondarily implanted and used in conjunction with an epicardial patch, in order to decrease the high defibrillation threshold observed with the previous epicardial system. Mean ± SD defibrillation threshold was 17 ± 6 joules (range 3-30). Fifteen pts (29%) had an associate surgical procedure. There were 5 perioperative deaths (9.6%) and 8 toperative complications (15%). Five deaths (10.6%) occurred during a 15 days to 40 months follow-up (mean ± SD 14 ± 10): 3 cases of congestive heart failure and 2 non cardiac deaths. No sudden death occurred. Actuarial incidence of sudden death, 0%, 16.5% and 18.4% at 1 year and 0%, 16.5% and 22.5% at 2 years. Thirty-one pts (66%) received shocks during follow-up (56% appropriate, 5% inappropriate, 39% indeterminate). In 4/6 pts antitachycardia pacing intervened, successfully converting the arrhythmia in 78% of cases. In conclusion, ICD provide high efficacy in preventing sudden death. Nonthoracotomic approaches can potentially reduce the operative risk associated with thoracotomic implantation, particularly in patients with left ventricular dysfunction and need for concomitant surgery. Further studies are needed to assess the ICD real effect on long-term total mortality rates, in pts with severely depressed left ventricular function.

Original languageEnglish
Pages (from-to)827-835
Number of pages9
JournalNew Trends in Arrhythmias
Volume7
Issue number4
Publication statusPublished - 1991

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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