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An automatic, implantable cardioverter-defibrillator (AICD) which generates a high-energy current impulse is now available for the management of treatment-resistant malignant ventricular arrhythmias. Such a device (manufactured by Intec/CPI) was implanted into eight patients with coronary heart disease or dilated cardiomyopathy, and in four after surgery for postinfarction ventricular arrhythmias. All patients had had life-threatening episodes of ventricular fibrillation or tachycardia: the arrhythmias were refractory to multiple drug therapy (mean of 6.8 antiarrhythmia drugs per patient). The threshold energy for converting ventricular fibrillation was 9.6 Joules +/- 5.7. Except for one bacterial infection of the electrodes, there were no serious complications. During a mean observation period of 13.6 months 21 electrophysiologically induced and 105 spontaneous tachyarrhythmias were successfully terminated by the AICD. No malfunctions occurred and there was no death due to an arrhythmia.
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