THE EFFECT OF CORONARY-BYPASS GRAFT-SURGERY FOR THE PREVENTION OF SUDDEN CARDIAC DEATH - RECURRENT EPISODES AFTER ICD IMPLANTATION AND REVIEW OF LITERATURE

Sudden cardiac death (SCD) accounts for at least 50% of the mortality of patients with ischemic heart failure. Ventricular arrhythmias are r esponsible for most cases of sudden cardiac death. There is some evide nce that coronary artery bypass graft (CABG) surgery may reduce the in cidence of recurrent episodes of SCD by prevention of myocardial ische mia. To test the hypothesis that CABG surgery is effective in the prev ention of SCD, we compared the recordings of implantable cardioverter defibrillators (ICD) in patients who underwent ICD implantation alone (n = 64) or ICD implantation and concomitant CABG surgery respectively (n = 11). All patients had experienced out of hospital cardiac arrest . ICD recordings were obtained every 3 months and the number of recurr ent episodes of ventricular tachycardia (VT) for each time period was noted. Three months following ICD implantation patients in the surgica lly treated group had an average of one episode of VT per patient as c ompared to 2.7 episodes in the nonsurgical group. This difference was observed during the following months as well. However, at no time (up to 18 months of follow-up) this difference reached statistical signifi cance. There were no deaths in the surgically treated group. Although we could not demonstrate a statistical significant difference between the two groups, there was a tendency in the surgically treated group t o have less episodes of recurrent VT than in the medically treated gro up. We, therefore, conclude that survivors of SCD presenting with mult ivessel coronary artery disease (CAD) should undergo coronary artery b ypass grafting to prevent myocardial ischemia as the triggering event for lethal ventricular arrhythmias.