title: Implantable defibrillators for secondary prevention of sudden cardiac death in cardiac surgery patients with perioperative ventricular arrhythmias.
abstract: BACKGROUND
  Randomized studies of implantable cardioverter defibrillators (ICD) have excluded sudden cardiac death survivors who had revascularization before or after an arrhythmic event. To evaluate the role of ICD and the effects of clinical variables including degree of revascularization, we studied cardiac surgery patients who had an ICD implanted for sustained perioperative ventricular arrhythmias.
  
  
  RESULTS
  The electronic database for Southern California Kaiser Foundation hospitals was searched for patients who had cardiac surgery between 1999 and 2005 and an ICD implanted within 3 months of surgery. One hundred sixty-four patients were identified; 93/164 had an ICD for sustained pre- or postoperative ventricular tachycardia or fibrillation requiring resuscitation. Records were reviewed for the following: presenting arrhythmia, ejection fraction, and degree of revascularization. The primary end point was total mortality (TM) and/or appropriate ICD therapy (ICD-T), and secondary end points are TM and ICD-T. During the mean follow up of 49 months, the primary endpoint of TM+ICD-T and individual end points of TM and ICD-T were observed in 52 (56%), 35 (38%), and 28 (30%) patients, respectively, with 55% of TM, and 23% of ICD-T occurring within 2 years of implant. In multivariate risk analysis, none of the following was associated with any of the end points: incomplete revascularization, presenting ventricular arrhythmia, and timing of arrhythmias.
  
  
  CONCLUSIONS
  Our data supports the recent guidelines for ICD in this cohort of patients, as the presence of irreversible substrate and triggers of ventricular arrhythmias, cannot be reliably excluded even with complete revascularization. Further studies are needed to understand this complex group of patients.
authors.affiliation: Department of Electrophysiology, Kaiser Permanente Southern California, Los Angeles, CA (M.F.N.).
authors.forename: Maged F
authors.initials: MF
authors.lastname: Nageh
authors.affiliation: Department of Cardiology, Kaiser Permanente Southern California, Los Angeles, CA (J.J.K.).
authors.forename: John J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA (L.H.C., J.F.Y.).
authors.forename: Lie-Hong
authors.initials: LH
authors.lastname: Chen
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Los Angeles, CA (L.H.C., J.F.Y.).
authors.forename: Janis F
authors.initials: JF
authors.lastname: Yao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery*; D059035:Perioperative Period; D016016:Proportional Hazards Models; D055502:Secondary Prevention; D017180:Tachycardia, Ventricular / Q000150:complications / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy*
keywords: implantable defibrillator; perioperative ventricular arrhythmias; revascularization