Clinical evaluation of the internal automatic cardioverter-defibrillator in survivors of sudden cardiac death

Reid, Philip R.; Mirowski, M.; Mower, Morton M.; Platia, Edward V.; Griffith, Lawrence S.C.; Watkins, Levi; Bach, Stanley M.; Imran, Mir; Thomas, Andrea

doi:10.1016/0002-9149(83)90195-9

Cited by 107 publications

(7 citation statements)

References 14 publications

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“…(Circulation 1990;82:2035-2043) E lectrical devices have proved to be an effective method of therapy for several tachyarrhythmias. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The proper functioning of these devices requires not only that the device be capable of administering effective therapy but that the device also properly identify the presence of an arrhythmia. A new generation of these electronic devices will be capable of several modes of therapy, each appropriate for specific ventricular tachyarrhythmias.17-21 Such a device must therefore have some scheme that will allow it to detect the presence of, and differentiate between, these different tachyarrhythmias.…”

mentioning

confidence: 99%

Differentiation of ventricular tachyarrhythmias.

et al. 1990

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Implantable devices capable of several modes of therapy will require differentiation of various ventricular tachyarrhythmias. Three methods of arrhythmia analysis, magnitude-squared coherence, ventricular rate, and irregularity of cycle length were performed for 45 episodes of induced ventricular tachyarrhythmia in 15 patients. Differentiation of monomorphic ventricular tachycardia from polymorphic ventricular tachycardia and ventricular fibrillation was possible by mean magnitude-squared coherence, less possible by rate, and not possible by beat-to-beat irregularity. Faster monomorphic ventricular tachycardia overlapped with rates of polymorphic ventricular tachycardia and ventricular fibrillation. Differentiation of polymorphic ventricular tachycardia and ventricular fibrillation was not possible by rate or irregularity. A progressive decrease in mean magnitude-squared coherence from monomorphic ventricular tachycardia to polymorphic ventricular tachycardia to ventricular fibrillation strengthens previous observations that coherence is a measure of rhythm "organization."

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mentioning

confidence: 99%

Differentiation of ventricular tachyarrhythmias.

et al. 1990

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“…These survival statistics compare favorably with those from studies evaluating other therapies such as long-term antiarrhythmic drug administration and surgical ablation techniques.2 Recently, electrophysiologic studies have shown that in the majority of patients with sudden cardiac death, the initiating arrhythmia is rapid ventricular tachycardia. 3 4 Modifications in the design of the automatic implantable defibrillator5 6 resulted in the addition of a separate pair of sensing leads and the broadening of its application to include patients with sustained ventricular tachycardia as well as fibrillation.…”

mentioning

confidence: 99%

Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator.

Echt¹,

Armstrong²,

Schmidt³

et al. 1985

Circulation

435

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Seventy patients received the automatic implantable defibrillator, five original devices and 72 modified second-generation devices using only bipolar rate sensing and delivering an R wave synchronous cardioverting/defibrillating shock, for either ventricular tachycardia or fibrillation. The primary clinical arrhythmia was sustained ventricular tachycardia in 32 patients, ventricular fibrillation in 20 patients, and both ventricular tachycardia and fibrillation in 18 patients. Before implantation of the device the patients had survived 3.1 2.3 arrhythmic episodes, including 1.9 + 1.7 cardiac arrests, and had received 4.0 ± 2.1 antiarrhythmic drugs without improvement. Sixty-eight patients ultimately received devices. After a follow-up period of 8.9 ± 7.7 months (range 1 to 33), 37 patients received a total of 463 discharges. Inability to determine the precise reason for most discharges and the unpleasant nature of the discharges were the major clinical problems encountered. Complications included postoperative death (one patient), lead problems (six patients), inadequate energy requiring explanation (two patients), and pocket infection (one patient). Life-

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“…If the arrhythmia is not terminated by the electrical discharge, the device recycles and delivers additional shocks. The details of this cardioverter-defibrillator function have been discussed elsewhere (Mirowski et al, 1980Reid et al, 1983;Watkins et al, 1981). Worth emphasizing is the importance of antiarrhythmic drugs used in conjunction with the automatic cardioverter-defibrillator.…”

Section: Discussionmentioning

confidence: 99%

“…The possible risks of the cardioverterdefibrillator should not be underemphasized. Implantation of the system requires a thoracotomy to apply the apical patch lead, although a newer subxiphoid approach may lower the potential morbidity (Reid et al, 1983;Watkins et al, 1982). It is possible that sinus tachycardia above the rate cut-off 160 beatdmin with a wide QRS complex secondary to an intrinsic or dmg-induced intraventricular conduction delay, could cause the device to discharge inappropriately.…”

Section: Discussionmentioning

confidence: 99%

Management of the prolonged QT syndrome and recurrent ventricular fibrillation with an implantable automatic cardioverter‐defibrillator

Platia

Griffith

Watkins

et al. 1985

Clinical Cardiology

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Summary:Two patients with the prolonged QT syndrome and recurrent ventricular tachyarrhythmias are presented, one of them refractory to combination antiarrhythmic drug therapy and bilateral stellate ganglion blockade. We implanted and tested in vivo an automatic cardioverterdefibrillator to provide a cardiac monitoring system with the capability of delivering a 25 J electrical discharge to the heart if rapid ventricular tachycardia or ventricular fibrillation is detected. Arrhythmia induction in the electmphysiology laboratory confirmed the appropriate recognition of the arrhythmias in each patient, with prompt discharge of the device and resultant termination of the tachycardias. We suggest that implantation of such a device may provide an effective adjunct to antiarrhythmic drug therapy in the management of infrequent, but potentially lethal, ventricular arrhythmias occurring in patients with the prolonged QT syndrome.

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Clinical evaluation of the internal automatic cardioverter-defibrillator in survivors of sudden cardiac death

Cited by 107 publications

References 14 publications

Differentiation of ventricular tachyarrhythmias.

Differentiation of ventricular tachyarrhythmias.

Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator.

Management of the prolonged QT syndrome and recurrent ventricular fibrillation with an implantable automatic cardioverter‐defibrillator

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