Early experience with an implantable cardioverter

D. P. Zipes, J. J. Heger, W. M. Miles, Y. Mahomed, John Brown, S. R. Spielman, E. N. Prystowsky

Research output: Contribution to journalArticle

62 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)485-490
Number of pages6
JournalNew England Journal of Medicine
Volume311
Issue number8
StatePublished - 1984
Externally publishedYes

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Ventricular Tachycardia
Shock
Equipment and Supplies
Electric Countershock
Indwelling Catheters
Ventricular Fibrillation
Local Anesthesia
Bradycardia
Atrial Fibrillation
Heart Ventricles
Hospital Emergency Service
Cardiac Arrhythmias
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Zipes, D. P., Heger, J. J., Miles, W. M., Mahomed, Y., Brown, J., Spielman, S. R., & Prystowsky, E. N. (1984). Early experience with an implantable cardioverter. New England Journal of Medicine, 311(8), 485-490.

Early experience with an implantable cardioverter. / Zipes, D. P.; Heger, J. J.; Miles, W. M.; Mahomed, Y.; Brown, John; Spielman, S. R.; Prystowsky, E. N.

In: New England Journal of Medicine, Vol. 311, No. 8, 1984, p. 485-490.

Research output: Contribution to journalArticle

Zipes, DP, Heger, JJ, Miles, WM, Mahomed, Y, Brown, J, Spielman, SR & Prystowsky, EN 1984, 'Early experience with an implantable cardioverter', New England Journal of Medicine, vol. 311, no. 8, pp. 485-490.
Zipes DP, Heger JJ, Miles WM, Mahomed Y, Brown J, Spielman SR et al. Early experience with an implantable cardioverter. New England Journal of Medicine. 1984;311(8):485-490.
Zipes, D. P. ; Heger, J. J. ; Miles, W. M. ; Mahomed, Y. ; Brown, John ; Spielman, S. R. ; Prystowsky, E. N. / Early experience with an implantable cardioverter. In: New England Journal of Medicine. 1984 ; Vol. 311, No. 8. pp. 485-490.
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