Coronary Artery Bypass in Patients with Previously Placed Implantable Defibrillators

Four patients with previously placed implantable defibrillators required coronary revascularization several years after the original device was inserted. Three patients had a conventional system of epicardial patches and leads, and one patient had a nonthoracotomy system placed. All four patients were successfully revascularized without evidence of perioperative infarction or significant morbidity. The patient with the nonthoracotomy device did require manipulation of the endocardial lead at a separate setting. This limited experience suggests that patients needing revascularization after placement of an implantable defibrillator can be successfully bypassed.