ICD implantation with and without combined myocardial revascularisation--incidence of ICD therapy and late survival.
BACKGROUND
Our aim was to evaluate the occurrence of implanted cardioverter-defibrillator (ICD) shock and antitachycardia pacing (ATP), the effect of ICD therapies on mortality and the impact of revascularisation strategies on arrhythmic events.


METHODS
We investigated 130 CAD patients undergoing ICD implantation between 1984 and 1999.


RESULTS
Freedom of shock was 66 +/- 7 %, 48 +/- 9 % and 48 +/- 9 % after 1, 3 and 5 years in patients with revascularisation and 62 +/- 8 %, 43 +/- 8 % and 23 +/- 11 % in patients without revascularisation, respectively; p = n. s. Freedom from ATP was similar in both groups - in patients with revascularisation, 64 +/- 6 %, 58 +/- 7 % and 58 +/- 7 % and without revascularisation 56 +/- 8 %, 51 +/- 9 % and 38 +/- 10 %, respectively; p = n. s. There were no significant differences in cumulative survival between patients with and without revascularisation; p = n. s.


CONCLUSIONS
CAD patients with VT/VF and with implanted ICD have, despite successful revascularisation, the same rate of device therapy and mortality as patients without an indication of revascularisation. This implies that patients with chronic ischemic heart disease and ventricular tachyarrhythmias continue to be at risk of sudden death after CABG/PTCA; evaluation for ICD implantation is warranted.
Brockes
C
C
Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland. christiane.brockes@epost.de
Rahn-Schönbeck
M
M
Duru
F
F
Candinas
R
R
Seifert
B
B
Turina
M
M
D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000401:mortality / Q000628:therapy*