THE AUTOMATIC IMPLANTABLE DEFIBRILLATOR - CLINICAL-RESULTS IN 45 PATIENTS

The aim of this study was to analyse the efficacy and survival after i mplantation of an automatic cardioverter-defibrillator. Forty-five pat ients including 37 men were followed up for 0 to 51 months. The indica tions were ventricular fibrillation with no curable cause (n = 27) and sustained resistant or poorly tolerated ventricular tachycardia (n = 17) when programmed ventricular pacing with antiarrhythmic therapy was not applicable or gave poor results. One patient was implanted with t his device for torsades de pointes. The underlying cardiac disease was ischaemic in 34 cases, non-ischaemic in 8 cases, and 3 patients had n o apparent cardiac disease. Twenty patients were implanted with an epi cardial system (group I) and 25 patients with an endocardial system (g roup II). In group II, there was one complete failure of implantation requiring the use of an epicardial system and 2 partial failures requi ring an additional epicardial patch electrode. The perioperative morta lity was 2/45 (4.4%), both cases being due to permanent arrhythmias. I n 5 patients, the minimal effective energy of defibrillation was over 25 Joules at implantation, without any untoward consequences on the cl inical outcome. Ten non-fatal complications were observed including tw o major problems (haemopericardium): there were two cases of late incr ease of the minimal effective energy of defibrillation requiring the a ddition of a subcutaneous patch. Twenty-four patients (53%) received a t least one appropriate therapy; 14 patients (36%) had at least one in appropriate shock during follow-up. During follow-up, 7 patients died, 6 of a cardiac cause and 3 of an arrhythmic problem. These results co nfirm the low incidence of operative mortality and late complications after implantation of an automatic defibrillator, although the global mortality remains high.