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Long-term Clinical Experience and Outcome at a Hospital Without an Open-Heart Surgery Program

Todd J. Cohen, MD; Philip R. Reid, MD; Morton M. Mower, MD; M. Mirowski, MD; Diana Aarons, RN; Juan Juanteguy, MD; Enrico P. Veltri, MD

Arch Intern Med. 1992;152(1):65-69.

Abstract
From November 1982 through April 1989,111 patients with refractory sustained ventricular tachycardia/fibrillation had the automatic cardioverter-defibrillator implanted at our institution, the first community hospital involved in implantation of such a device. We have reviewed our longterm clinical experience to assess the feasibility, learning curve, and efficacy of device implantation in a facility with cardiac electrophysiology expertise but without open-heart surgery facilities. All patients were considered inoperable or at high risk for other concomitant surgery. Eighty-six patients (77%) underwent uneventful implantation. Nine patients (8%) died prior to hospital discharge. Operative mortality declined from 10.9% to 5.4% during the first half (55 patients; November 1982 through September 1986) and second half (56 patients; October 1986 through April 1989) of the experience. Other postoperative complications occurred in 16 patients (14%), 12 of whom experienced complications during the first half of the experience. At 22±20 (mean±SD) months' follow-up, 78 (76%) of 102 patients discharged were alive, and 24 patients (24%) had died. Fifty patients (49%) had experienced at least one automatic cardioverter-defibrillator discharge associated with hypotensive symptoms. The actuarial incidence of sudden death at 1,2, and 3 years was 1.2%, 5.5%, and 6.2%, respectively. We concluded that the automatic implantable cardioverter-defibrillator is an effective therapy for refractory ventricular tachycardia/fibrillation and that device implantation at community hospitals with an experienced cardiac electrophysiology team is both feasible and practical.

(Arch Intern Med. 1992;152:65-69)

Author Affiliations
From the Cardiology Division, Departments of Medicine and Surgery, Sinai Hospital of Baltimore (Md). Drs Cohen, Reid, and Mower are now with the Cardiology Division, University of California at San Francisco, Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, Ind, and Cardiac Pacemakers Inc, St Paul, Minn, respectively.

Footnotes
Accepted for publication September 9, 1991.

Reprint requests to the Division of Cardiology, Sinai Hospital of Baltimore, Belvedere at Greenspring Ave, Baltimore, MD 21215 (Dr Veltri).

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