A one-stage strategy of simultaneous ICD placement during coronary revascularization yielded similar 3-year survival compared to a two-stage selective strategy (88% vs 76%, NS).
Cohort (n=79)
Does a one-stage strategy compared to a two-stage strategy improve survival in patients undergoing myocardial revascularization and ICD implantation?
Both one- and two-stage strategies for ICD implantation during coronary revascularization largely prevent sudden death, with no significant difference in 3-year survival, though both carry risks of operative mortality and infection.
Absolute Event Rate: 88% vs 76%
p-value: p=NS
Internal defibrillation leads were placed at time of coronary revascularization in 79 patients. In 34, an implantable cardioverter defibrillator (ICD) was placed simultaneously (group I). A two-stage strategy (selective implantation of the ICD in patients with postoperative spontaneous or inducible ventricular tachycardia VT) was followed in 45 patients (group II). Group I patients had failed more antiarrhythmic drug trials (2.9 +/- 1.6 vs 1.5 +/- 1.6; P = 0.02), including amiodarone (62% vs 20%; P less than 0.001). There were four operative deaths in each group. Postoperatively, VT was present in 27 group II patients (60%), 25 of whom received an ICD (two refused device implantation). Patients with postoperative VT had a lower left ventricular ejection fraction than those without VT (33 +/- 9 vs 47 +/- 16; P = 0.01). Actuarial survival at 1, 2, and 3 years was 88 +/- 6, 88 +/- 7, and 88 +/- 10 in group I; and 83 +/- 6, 76 +/- 7, and 76 +/- 11 in group II (NS). No patient without an ICD (based on the postoperative electrophysiological study EPS) died suddenly. Five patients (6%) had ICD system infection. Sudden death was largely prevented by either strategy, but relatively high rates of operative mortality and ICD system infection were observed. Prospective studies should identify patients more likely to benefit from one or another strategy.
Pinski et al. (Mon,) conducted a cohort in Myocardial revascularization and ICD implantation (n=79). One-stage strategy (simultaneous ICD placement) vs. Two-stage strategy (selective ICD implantation) was evaluated on Actuarial survival at 3 years (p=NS). A one-stage strategy of simultaneous ICD placement during coronary revascularization yielded similar 3-year survival compared to a two-stage selective strategy (88% vs 76%, NS).