Initial clinical experience with a fully automatic in-hospital external cardioverter defibrillator

Sudden cardiac death due to ventricular tachyarrhythmia remains a significa nt problem in the in-hospital setting. Although the probability of survival is closely correlated with the rapidity of a response by qualified personn el, response times can be prolonged, even in specialized care units. in an effort to decrease response time, a fully automatic external cardioverter d efibrillator was recently devised. This device was evaluated in the in-hosp ital setting to assess safety and efficacy. A total of 79 patients were stu died in a multicenter trial. Patients were monitored with fully functional devices in the electrophysiology laboratory (51 patients) and in the cardia c care unit (28 patients). Performance of the device was assessed by compar ing automatic responses to any sustained change in cardiac rhythm, either s pontaneous or induced, to a retrospective review of stored ECG data and pro grammed parameters. During a total duration of 964 hours of monitoring, the re were 99 episodes of sustained tachycardia. Therapy was appropriately del ivered or advised in all episodes. Therapy Mras advised in one episode of s upraventricular tachycardia. There were no episodes of inappropriate therap y delivery. There were no complications or adverse events. The device perfo rmed with a sensitivity of 100 % and specificity of 98.8 % with an average response time of 22 seconds. In conclusion, this automatic external defibri llator was safe, effective, and functioned as designed. Significant improve ment in response time to life-threatening ventricular tachyarrhythmia in th e in-hospital setting would be expected if this technology was widely adopt ed.