Stratified application of the automatic implantable cardioverter defibrillator. J Thorac Cardiovasc Surg 1988 Jul;96(1):141-9
Date
07/01/1988Pubmed ID
3386288DOI
10.1016/s0022-5223(19)35307-3Scopus ID
2-s2.0-0023762575 (requires institutional sign-in at Scopus site) 25 CitationsAbstract
Since June 1983 we have developed a stratified regimen for staged implantation of the automatic implantable cardioverter defibrillator system. The protocol for management in patients who have fully recovered from sudden cardiac death is initiated with the use of standard electrophysiologic evaluation. Treatment in order of application has consisted of drugs followed by implantation of the device for patients with drug-refractory arrhythmias in whom direct cardiac surgical intervention for anatomic substrates for sudden death are absent. In surgical candidates, combinations of coronary revascularization and ablative therapy have been used to mitigrate the potential for lethal arrhythmia. Sensing and defibrillator lead systems have been placed at corrective operations to be followed later by implantation of the cardioverter defibrillator generator for either inducible or spontaneous tachyarrhythmia. This staged application has been effective in markedly reducing actual sudden cardiac death while at the same time saving on unnecessary device implantation. Morbidity of lead implantation alone remains a concern, particularly for infective complications. Additional follow-up is required to assess the validity of this approach.
Author List
Olinger GN, Chapman PD, Troup PJ, Almassi GHAuthor
G Hossein Almassi MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Anti-Arrhythmia AgentsCardiopulmonary Bypass
Combined Modality Therapy
Death, Sudden
Electric Countershock
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization
Tachycardia
Ventricular Fibrillation
