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Ann Thorac Surg 1983;35:361-366
© 1983 The Society of Thoracic Surgeons

Articles

The Effects of Cardiovascular Drugs on the Defibrillation Threshold and the Pathological Effects on the Heart Using an Automatic Implantable Defibrillator

G. Michael Deeb, M.D.*, Robert L. Hardesty, M.D., Bartley P. Griffith, M.D., Mark E. Thompson, M.D., M. Stephen Heilman, M.D., Richard L. Myerowitz, M.D.

From the Departments of Surgery, Cardiology, and Pathology, University of Pittsburgh School of Medicine, Presbyterian-University Hospital, Pittsburgh, PA

Accepted for publication April 1, 1982.

* Address reprint requests to Dr. Deeb, Department of Surgery, 1088 Scaife Hall, Pittsburgh, PA 15261

Internal defibrillating leads were implanted in 6 dogs through a left thoracotomy and in 6 pigs through a subxiphoid approach. The effects of digoxin (0.04 mg per kilogram of body weight), procainamide (15 mg per kilogram), and propranolol (0.2 mg per kilogram) on the defibrillation threshold was determined 30 to 60 minutes following intravenous administration. Resultant blood levels were equal to or greater than therapeutic levels. Individually these drugs resulted in no appreciable change in the defibrillation threshold from baseline. Pathological study of the myocardium obtained from 6 dogs that underwent more than two hundred shocks each did not demonstrate any abnormality. The 6 pigs were reliably defibrillated, this indicating that thoracotomy is not required for successful implantation.

The automatic implantable defibrillator is not the definitive treatment for recurrent ventricular arrhythmias, but is a practical regimen of therapy for a select group of high-risk, out-of-hospital patients. These observations advance our knowledge of the use of this device and give more assurance for future implantation in this select group of patients.






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Copyright © 1983 by The Society of Thoracic Surgeons.