The evolution of internal defibrillators.

ICDs have reduced mortality from SCD to 2% per year, which is a record unmatched by any other form of therapy. With continued evolution, ICD systems should become easier to implant, smaller, more effective in managing a variety of abnormal rhythms, and more comfortable for the patient. Implementation of technological innovations in future-generation devices should continue to extend the frontiers as clinicians consider ICDs for an expanding range of therapeutic applications.

Daily variations in the occurrence of symptomatic supraventricular tachycardia as determined by ambulatory event monitoring.

The diurnal incidence of supraventricular tachycardia (SVT), including atrial fibrillation and atrial flutter, has been quantified by examining 7,891 cases of symptomatic arrhythmia in 5,869 patients assigned to ambulatory monitoring using electrocardiographic event recorders with transtelephonic reporting. The probability of occurrence of SVT was found to be high and moderately variable throughout the normally active hours of the day between 8 A.M. and 8 P.M. and to be uniformly low during the inactive hours between 1 and 5 A.M. Age-related peaks within the active phase were independently associated with the older half of the study population (9 A.M.) and with the younger half (6 P.M.). The daily incidence of SVT is primarily characterized by 2 states of activity, active and quiescent. Quiescence of SVT is associated with normal sleep and inactivity.

The shocking lung mass: a case report.

Two years after implantation of an ICD with epicardial patch leads, a patient presented with hemoptysis. The posterior left ventricular patch was found to have eroded into lingular segmental bronchus. During thoracotomy, the hardware was removed and the bronchus successfully repaired.

Compatibility of a nonthoracotomy lead system with a biphasic implantable cardioverter-defibrillator. Cadence-Endotak 60-Series IDE investigators.

This prospective multicenter study was conducted under the Food and Drug Administration Investigational Device Exemption to evaluate the safety and efficacy of the combination of the Cadence implantable defibrillator (Ventritex, Inc.) and 60-series Endotak C leads (Cardiac Pacemakers, Inc.). Implantation was attempted in 148 patients with hemodynamically compromising ventricular tachycardia or fibrillation (VF), or with pace-terminable ventricular tachycardia. The system was successfully implanted in 97% of patients, with 96% of implants in a transvenous-lead-alone configuration. At implantation, the defibrillation threshold was 455 +/- 94 V (14 +/- 6 J) for lead-alone patients and 532 +/- 40 V (19 +/- 3 J) for those requiring a subcutaneous patch. VF conversion efficacy was reconfirmed in patients who underwent a 3-month chronic induction study. The system successfully detected all 763 induced arrhythmias and terminated 99.5% of them; after system modification, successful conversion was demonstrated in the 2 patients who initially had induced episodes requiring external defibrillation (1 lead revision; 1 reprogramming). All spontaneous episodes were terminated with an implantable-cardioverter defibrillator. Postshock VF redetection times were significantly shorter than initial detection times (4.5 +/- 1.8 seconds detection, 2.1 +/- 0.7 seconds redetection; p<0.0001). During an 8-month mean follow-up (range 1 to 31 months), 2 unwitnessed deaths were classified as sudden cardiac deaths, and 11 patients experienced a total of 12 complications, none of which was associated with the Cadence-Endotak combination.