Perioperative management of the patient undergoing automatic internal cardioverter-defibrillator implantation.

I T HAS BEEN ESTIMATED that 400,000 people die annually from sudden cardiac arrest in the United States.’ Various treatment modalities have been tried in patients at high risk for sudden death from ventricular fibrillation, but delivery of an electrical countershock of sufficient energy remains the only reliable treatment.* The automatic internal cardioverterdefibrillator (AICD) has dramatically changed the treatment of patients at high risk for sudden death. The first clinical trial was by Mirowski et al3 in 1980. The implantation of AICDs has greatly increased since the Food and Drug Administration approved the device in 1985. There have been more than 3,000 AICDs inserted since 1982, at greater than 200 centerse4 The results of conventional treatment are not optimal. The l-year sudden-cardiac-death rate for survivors of an episode of cardiac arrest receiving empiric drug therapy is 20% to 50%.5-9 The l-year sudden-cardiac-death rate for patients with electrophysiologic or Holter-monitorguided therapy is 2% to 1 5%.5,6Y9 The results from a number of series of patients with AICDs, however, have been very encouraging. The lyear sudden-cardiac-death rate of AICD patients has been reported to be about 2%.‘@14