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Early Experience with an Implantable Cardioverter
Journal article   Peer reviewed

Early Experience with an Implantable Cardioverter

Douglas P Zipes, James J Heger, William M Miles, Yousuf Mahomed, John W Brown, Scott R Spielman and Eric N Prystowsky
The New England journal of medicine, v 311(8), pp 485-490
23 Aug 1984
PMID: 6749205

Abstract

Anesthesia Bradycardia Cardiac arrhythmia Cardiology Catheters Early experience Electrocardiography Electrodes Emergency medical care Fibrillation Heart attacks Ostomy Patients Tachycardia Transplants & implants Ventricle
Abstract We tested the efficacy and safety of a fully programmable cardioverter weighing 95 g, in terminating sustained ventricular tachycardia. The device was implanted transvenously under local anesthesia in seven patients. On command from a programmer or automatically, the cardioverter delivered shocks through a lead inserted to the apex of the right ventricle. It also served as a demand ventricular pacemaker and could perform programmed ventricular stimulation or overdrive pacing. Cardioversion of ventricular tachycardia required less than 0.5 J (mean) and was well tolerated by the patients, who were awake and not sedated. In one patient, a shock terminated ventricular tachycardia with the device in the automatic mode but produced atrial fibrillation with a rapid ventricular response that was intermittently recognized as ventricular tachycardia, triggering additional shocks. One such shock in the ST segment produced ventricular fibrillation that was terminated transthoracically in the emergency room, without residual impairment. We conclude from these preliminary observations that cardioversion of sustained ventricular tachycardia by means of an implantable catheter device is feasible, but for the present its use in the automatic mode must be cautious and selective. The unit's small size, ease of implantation, usefulness for noninvasive electrophysiologic studies, programmability, and bradycardia pacing functions are advantages. The next-generation device must be able to defibrillate and provide better differentiation of arrhythmias. (N Engl J Med 1984; 311:485-90.)

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Collaboration types
Domestic collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
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