title: Incidence of implantable defibrillator discharges after coronary revascularization in survivors of ischemic sudden cardiac death.
abstract: Coronary revascularization has been suggested as sole therapy for secondary prevention of sudden cardiac arrest associated with ischemia. The use of implantable defibrillators (ICD) in combination with coronary revascularization for this patient population is unclear. Among 412 consecutive patients receiving an ICD, 23 (6%) were identified as sudden cardiac arrest survivors who were noninducible with programmed stimulation and had unstable angina or ischemia on a functional study; they underwent successful coronary revascularization. During a follow-up of 34 +/- 18 months, 10 (43%) of the 23 patients received ICD shocks (8 +/- 8 per patient, range 1 to 22 shocks), and nine of the 10 patients had syncope/presyncope associated with at least one ICD discharge. Patients with ICD discharges were compared with those without ICD discharges, and no clinical characteristics were statistically different between the two groups. In conclusion, revascularization alone may be inadequate therapy for survivors of sudden cardiac arrest associated with ischemia who are noninducible with programmed stimulation, and clinical variables cannot predict which patients are likely to have recurrent malignant ventricular arrhythmias.
authors.affiliation: Department of Internal Medicine, University of Michigan Hospital, Ann Arbor 48109, USA.
authors.forename: E G
authors.initials: EG
authors.lastname: Daoud
authors.forename: M
authors.initials: M
authors.lastname: Niebauer
authors.forename: W H
authors.initials: WH
authors.lastname: Kou
authors.forename: K C
authors.initials: KC
authors.lastname: Man
authors.forename: L
authors.initials: L
authors.lastname: Horwood
authors.forename: F
authors.initials: F
authors.lastname: Morady
authors.forename: S A
authors.initials: SA
authors.lastname: Strickberger
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004594:Electrophysiology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D009204:Myocardial Revascularization; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017741:Survivors