INFLUENCE OF CORONARY ARTERY BYPASS GRAFTING AND CORONARY ANGIOPLASTY ON OCCURRENCE OF IMPLANTABLE CARDIOVERTER - DEFIBRILLATOR SHOCKS








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INFLUENCE OF CORONARY ARTERY BYPASS GRAFTING AND CORONARY ANGIOPLASTY ON OCCURRENCE OF IMPLANTABLE CARDIOVERTER - DEFIBRILLATOR SHOCKS
J. Kaźmierczak, L. Jordaens*
Department of Cardiology, Pomeranian Medical School, Szczecin, Poland; *Department of Cardiology, University Ghent, Belgium

Ischemia might be the cause for malignant ventricular arrhytmias leading to discharges of the ICD's in patients with coronary artery disease (CAD). Therefore we analysed in this study whether correction of ischemia by bypass operation. (CABG) or angioplasty (PTCA) at the time of or immediately (<2 weeks) before ICD implantation was related with a lower occurrence of shocks after hospital discharge. Of 143 patients, a total number of 17 underwent CABG, 6 had PTCA (gr 1), 28 had a CABG in the past without evidence of residual ischemia (gr 2), and 92 had no residual ischemia had only medical therapy for CAD (gr 3). The indication for ICD implantation was ventricular fibrillation in 66 pts. ventricular tachycardia in 71. A thoracotomy approach was used in 16 pts. There were no differences in age, sex distribution or indications for ICD between groups


 

Time to 1st S (days)

pts with S
no (%)

Survival
No (%)

EF
(%)

follow-up
(months)


Group 1
Group 2
Group 3

95± 118*
260± 310
194± 242

16 (70)
18 (64)
60 (65)

18 (78)
28 (100)
71 (77)

41± 14S
32± 10
32± 14

40± 37
44± 28#
33± 26



*p<0.05 vs group 2 and group 3; #p<0.05 vs group 3; S=shock
Sp<0,05 vs group 2 and p<0,001 vs group 3; EF=ejection fraction; no=number
No differences in survival between groups were observed. The indication and the approach played no role in the proportion of pts receiving shocks. The delay to the first shock after hospital discharge in patients with correction of ischemia at the time of implantation, even while these have a better cardiac function than the other groups.


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