Palatianos G M, Thurer R J, Cooper D K, Georgakakis G E, Tucker R L, Fernandez P, Interian A, Myerburg R J
Division of Thoracic Surgery, University of Miami School of Medicine/Jackson Memorial and Veterans Administration Medical Centers, Florida.
Pacing Clin Electrophysiol. 1991 Feb;14(2 Pt 2):297-301. doi: 10.1111/j.1540-8159.1991.tb05110.x.
To evaluate the effectiveness of the automatic implantable cardioverter-defibrillator (AICD), a 7-year experience, from 1983-1990, was reviewed. A total of 111 patients received an AICD device. Their ages ranged between 8 and 83 years. Mean age was 63.9 years. There were 91 men and 20 women. Eighty of the patients received the AICD following an out-of-hospital cardiac arrest, while 31 were suffering from intermittent symptomatic ventricular tachycardia. The underlying etiology in 97 patients (87%) was ischemic coronary artery disease, in 11 patients (10%) dilated cardiomyopathy, and in 3 patients (3%) idiopathic ventricular fibrillation. Mean ejection fraction was 33.2%. Implantation of the AICD was performed via a left thoracotomy in 39 patients, median sternotomy in 49 patients and subxiphoid-subcostal approach in 23 patients. In-hospital mortality occurred in one patient who suffered an acute myocardial infarction 4 hours postoperatively. Out-of-hospital mortality was observed in 19 patients. There were two arrhythmic deaths. Follow-up was available for 107 patients. Mean follow-up was 33.1 months. Sixty-six patients (62%) had AICD shocks. The initial appropriate shocks occurred during the first postimplantation year in 91% of the patients. In 53 of the survivors, initial AICD shocks took place within 4.4 +/- 4.7 months from implantation. Thirteen of the 20 patients who died had received appropriate AICD shocks. In these patients, the time between implantation and first shock was 2.7 +/- 3.6 months whereas the time between implantation and death was 11.3 +/- 10.3 months (NS). We conclude that the AICD is effective in converting ventricular tachyarrhythmias and prolongs survival.
为评估植入式自动心脏除颤器（AICD）的有效性，我们回顾了1983年至1990年这7年间的使用经验。共有111例患者接受了AICD装置。他们的年龄在8岁至83岁之间，平均年龄为63.9岁。其中男性91例，女性20例。80例患者在院外心脏骤停后接受了AICD，31例患有间歇性症状性室性心动过速。97例患者（87%）的潜在病因是缺血性冠状动脉疾病，11例患者（10%）是扩张型心肌病，3例患者（3%）是特发性心室颤动。平均射血分数为33.2%。39例患者通过左胸切开术植入AICD，49例患者通过胸骨正中切开术植入，23例患者通过剑突下 - 肋下入路植入。1例患者在术后4小时发生急性心肌梗死，死于院内。观察到19例患者发生院外死亡，其中有2例为心律失常性死亡。107例患者获得了随访，平均随访时间为33.1个月。66例患者（62%）接受了AICD电击。91%的患者在植入后的第一年内首次发生恰当电击。在53例存活患者中，首次AICD电击发生在植入后4.4±4.7个月内。死亡的20例患者中有13例接受了恰当的AICD电击。在这些患者中，植入至首次电击的时间为2.7±3.6个月，而植入至死亡的时间为11.3±10.3个月（无显著性差异）。我们得出结论，AICD在转复室性快速性心律失常方面有效，并能延长生存期。
