The Journal of Thoracic and Cardiovascular Surgery, Vol 86, 381-387, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Trials of the automatic implantable defibrillator in man. A three-year program report
L Watkins Jr, MM Mower, PR Reid, EV Platia, LS Griffith and M Mirowski
Since February, 1980, 65 survivors of multiple arrhythmic cardiac arrests
unresponsive to therapy were referred for implantation of the automatic
defibrillator. In 37 patients (Group I), automatic defibrillator
implantation alone was performed by subxiphoid insertion (20 patients) or
thoracotomy (17 patients). In another 28 patients (Group II), implantation
was combined with definitive cardiac procedures--coronary artery bypass
grafting in seven patients, bypass grafting and mitral valve replacement in
four patients, and left ventricular aneurysmectomy with endocardial
resection in 17 patients. There were no surgical deaths in Group I; four
operative deaths occurred in Group II. The longest follow-up has been 34
months, average 15.6 months. Following hospital discharge, 44 episodes of
automatic out- of-hospital resuscitation were observed in 11 Group I
patients. Similarly, four resuscitations were observed in two Group II
patients. Hypothetical survival curves based on the assumption that these
out-of- hospital resuscitations were lifesaving indicated expected 1 year
survivals rates of 45% in Group I and 85% in Group II. Excluding the
perioperative deaths that were unrelated to the defibrillator, the actual 1
year survival rates observed were 75% and 95% in Groups I and II,
respectively. Although definitive operation markedly reduced the number of
out-of-hospital arrhythmic episodes, the automatic defibrillator appears to
increase survival both when implanted alone and when used in combination
with cardiac procedures.
