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Ann Thorac Surg 1994;58:1297-1303
© 1994 The Society of Thoracic Surgeons

Articles

Clinical experience with the implantable cardioverter defibrillator

J.Mark Williams, MD*, David T. Rock, MD, Susan J. Pabst, MD, Catherine R. Grill, RN, Harry J. DeAntonio, DO, Rehan Mahmud, MD, W.Randolph Chitwood, Jr, MD

Divisions of Cardiothoracic Surgery and Cardiology, East Carolina University School of Medicine, Greenville, North Carolina, USA

* Address reprint requests to Dr Williams, Department of Surgery, East Carolina University School of Medicine, Greenville, NC 27858.

The implantable cardioverter defibrillalor has played an increasingly greater role in the management of episodes of sudden cardiac-related death related to ventricular tachycardia or ventricular fibrillation. This study reviews the cases of 142 patients who underwent insertion of an implantable cardioverter defibrillator, 104 who received a device alone (group I) and 38 who underwent insertion of the device in combination with other cardiac surgical procedures (group II). The overall operative mortality was 3.5% and this did not differ between the two groups. The complication rate was higher for group II than for group I patients, and consisted primarily of an increased incidence of atrial arrhythmias (53% versus 13%; p < 0.001). Late complications included three device infections requiring removal of the defibrillator. The late mortality did not differ between the two groups and was primarily related to congestive heart failure. Sudden cardiac-related death was an uncommon late event, with an actuarial freedom from sudden cardiac-related death of 98%, 97%, and 87% at 1, 2, and 5 years, respectively. The morbidity and mortality rate are low in association with the insertion of an implantable cardioverter defibrillator, even when this is combined with other cardiac surgical procedures. Its insertion is also associated with a low subsequent rate of sudden cardiac-related death.






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Copyright © 1994 by The Society of Thoracic Surgeons.