Implantable Defibrillators for Secondary Prevention of Sudden Cardiac Death in Cardiac Surgery Patients With Perioperative Ventricular Arrhythmias
| Autor: | Lie‐Hong Chen, Maged F. Nageh, Janis F. Yao, John J. Kim |
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| Rok vydání: | 2014 |
| Předmět: |
implantable defibrillator
Male medicine.medical_specialty perioperative ventricular arrhythmias Databases Factual medicine.medical_treatment Myocardial Ischemia Implantable defibrillator Revascularization Ventricular tachycardia Sudden cardiac death Internal medicine Secondary Prevention medicine Humans Arrhythmia and Electrophysiology Coronary Artery Bypass Perioperative Period Original Research Aged Proportional Hazards Models Aged 80 and over Ejection fraction business.industry Perioperative Middle Aged medicine.disease Defibrillators Implantable Cardiac surgery Death Sudden Cardiac Ventricular Fibrillation Ventricular fibrillation cardiovascular system Tachycardia Ventricular Cardiology revascularization Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| DOI: | 10.1161/jaha.113.000686 |
| Popis: | 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. Methods and 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. Conclusion 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. |
| Databáze: | OpenAIRE |
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