The automatic implantable cardioverter-defibrillator: management issues relevant to the emergency care provider

The automatic implantable cardioverter-defibrillator (AICD) is being used more frequently in patients with recurrent malignant arrhythmias refractive to sophisticated antiarrhythmic drug therapy. Such patients often present to emergency facilities with cardiac and/or device related complaints. Both "appropriate" and "inappropriate" AICD pulsing can result in patient adversity. For this reason AICD generator deactivation is indicated in certain clinical conditions once a controlled and properly equipped medical environment is assured. This report discusses a number of relevant emergent management issues concerning this beneficial device.