Automatic defibrillation in man. The initial surgical experience.

The automatic implantable defibrillator is an electronic device designed to detect and promptly correct malignant ventricular arrhythmias. Nineteen patients, all survivors of multiple cardiac arrests because of ventricular arrhythmias unresponsive to therapy, have undergone implantation of the automatic defibrillator. In seven patients who had had a previous cardiac operation, implantation was performed through a left lateral thoracotomy. A median sternotomy was used in five patients without a previous operation. In six patients cardiac procedures were performed concomitantly with defibrillator implantation. There were no operative deaths. The average follow-up is 6 months, the longest being 14 months. Following implantation, 47 episodes of malignant ventricular arrhythmias were documented. Twenty-six occurred spontaneously (17 of them outside the hospital); all were corrected with a single 25 joule pulse. Seventeen of 21 arrhythmias induced postoperatively were terminated. Although further validation is required, this study demonstrates that the automatic defibrillator is capable of diagnosing and terminating potentially lethal ventricular arrhythmias. Finally, implantation can be safely accomplished in an exceedingly high risk population.