Comparison of the usefulness of the implantable cardioverter-defibrillator and subendocardial resection in patients with sustained ventricular arrhythmias and poor regional wall motion associated with coronary artery disease.
The implantable cardioverter-defibrillator (ICD) and subendocardial resection are effective forms of therapy for sustained ventricular arrhythmias associated with coronary artery disease in selected patients. The relative efficacy of these 2 treatments in equivalently matched patients is not known. A regional wall motion score has been shown to be a powerful predictor of long-term outcome after both ICD implantation and subendocardial resection. This study retrospectively analyzed the long-term outcome of patients with coronary artery disease and ventricular arrhythmias treated during the same period with an ICD (n = 53) or by subendocardial resection (n = 65). Treatment outcomes were compared in subgroups determined by preoperative regional wall motion scores of either < or = 16 or > 16%. The 3-year cardiac mortality of the 2 therapies was not significantly different among patients with a wall motion score of > 16% (0% ICD vs 11% endocardial resection) or of < or = 16% (41% ICD vs 35% endocardial resection). Similarly, the 3-year sudden cardiac death mortality was similar among patients with a score of > 16% (0% for both ICD and endocardial resection) or of < or = 16% (9% ICD vs 14% endocardial resection, p = NS). At 24 months after hospital discharge, the percentage of patients who were in New York Heart Association functional class I or II was similar among patients with a wall motion score of > 16% (75% ICD vs 86% endocardial resection, p = NS) or with a wall motion score of < or = 16% (26% ICD vs 45% endocardial resection, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
Nath
S
S
Department of Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
Haines
D E
DE
DeLacey
W A
WA
Berry
V A
VA
Barber
M J
MJ
Kron
I L
IL
DiMarco
J P
JP
D002423:Cause of Death; D003327:Coronary Disease / Q000503:physiopathology* / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D004699:Endocardium / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*