INCIDENCE OF IMPLANTABLE DEFIBRILLATOR DISCHARGES AFTER CORONARY REVASCULARIZATION IN SURVIVORS OF ISCHEMIC SUDDEN CARDIAC DEATH

Coronary revascularization has been suggested as sole therapy for seco ndary prevention of sudden cardiac arrest associated with ischemia. Th e use of implantable defibrillators (ICD) in combination with coronary revascularization for this patient population is unclear. Among 412 c onsecutive patients receiving an ICD, 23 (6%) were identified as sudde n cardiac arrest survivors who were noninducible with programmed stimu lation and had unstable angina or ischemia on a functional study; they underwent successful coronary revascularization. During a follow-up o f 34 +/- 18 months, 10 (43%) of the 23 patients received ICD shocks (8 +/- 8 per patient, range 1 to 22 shocks), and nine of the 10 patients had syncope/presyncope associated with at least one ICD discharge. Pa tients with ICD discharges were compared with those without ICD discha rges, and no clinical characteristics were statistically different bet ween the two groups. In conclusion, revascularization alone may be ina dequate therapy for survivors of sudden cardiac arrest associated with ischemia who are noninducible with programmed stimulation, and clinic al variables cannot predict which patients are likely to have recurren t malignant ventricular arrhythmias.