Automatic implantable cardioverter-defibrillator: early experience at Wilford Hall USAF Medical Center.

Fifteen patients with malignant ventricular arrhythmias were treated with the automatic implantable cardioverter-defibrillator (AICD) over a 22-month period. The cause of the arrhythmia was coronary artery disease in 13 of the patients (87%), sarcoid cardiomyopathy in one (7%), and a primary electrical abnormality in one (7%). The mean ejection fraction was 29%, with a range of 15% to 70%. Fourteen of the patients had inducible ventricular tachycardia using program stimulation. Defibrillating and rate-sensing leads were inserted through a lateral thoracotomy in 13 patients and through a median sternotomy in two patients in conjunction with other cardiac procedures. The generators were positioned in a subcutaneous pocket beneath the left costal cartilage. There was one early and one late death, both due to congestive heart failure. Neither was related to a ventricular tachyarrhythmia, and in each patient the AICD was functioning properly at the time of death. The mean follow-up period was 11.5 months, with five patients receiving a total of 17 shocks. We conclude that the AICD is a highly effective, low-risk treatment for malignant ventricular tachyarrhythmias.