ANESTHESIA AND AUTOMATIC IMPLANTABLE CARD IOVERTER-DEFIBRILLATOR

Since the introduction of first generation automatic implantable cardi overter defibrillators (AICD) in 1980, an increasing number of such de vices have been inserted in patients at high risk for sudden death by Ventricular tachycardia or fibrillation (VT/VF). With the improvement of technology and implanting techniques, devices may be inserted at pr esent subcutaneously into the abdominal or the thoracic wall, rather t han by thoracotomy. The anaesthesist is involved in the primary implan tation of the AICD and the secondary testing of efficiency. Implantati on generally requires general anaesthesia and the extension of monitor ing is guided by the patient's underlying disease(s). The efficiency o f the implanted system is tested one to two months later in inducing V T/VF under general anaesthesia and in determining the defibrillation t hreshold. The anaesthetist may also have to take care of patients with a AICD. For such cases the following recommendations can be made: a) gloves shoud be worn by doctors and nurses coming into contact with th ese patients, in order to limit the risk of electrification; b) a ring magnet must be available to inactivate the unit; c) in case of extern al defibrillation, the external paddles should be oriented perpendicul arly to the line joining the two implanted electrodes; d) AICD should be disabled during electrocautery and prior to electroconvulsive thera py; e) the assistance of a electrophysiologist may be helpful for the management of these patients.