Patient Selection and Preoperative Evaluation for the Implanted Defibrillator

C hapman PD: Patient selection and preoperative evaluation for the implanted defibrillator . The automatic implantable cardioverter‐defibrillator (AICD), when applied as an investigational treatment modality, has demonstrated dramatic efficacy in reducing the sudden death rate in patients at high risk of recurrent lethal arrhythmias. Patient selection criteria have been liberalized somewhat since patients were selected for the initial clinical study but it is still necessary for patients to have survived either one episode of cardiac arrest due to ventricular arrhythmias not associated with myocardial infarction or to have either recurrent ventricular tachycardia or ventricular fibrillation refractory to conventional antiarrhythmic therapy. Patients with spontaneous recurrences of sustained ventricular tachyarrhythmias despite antiarrhythmic therapy are appropriate candidates whether or not their arrhythmias are inducible during electrophysiological study. All potential candidates must have a complete cardiac evaluation including cardiac catheterization with coronary angiography, exercise stress testing, electrophysiological study, and serial drug testing. Patients must also be candidates for general anesthesia and surgery for implantation of the AICD. AICD model selection is determined by analysis of the results of the cardiac evaluation .