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Ann Thorac Surg 1988;46:13-19
© 1988 The Society of Thoracic Surgeons

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Articles

Impending Sudden Cardiac Death: Treatment with Myocardial Revascularization and the Automatic Implantable Cardioverter Defibrillator

Departments of Surgery and Medicine, The Johns Hopkins Medical Institutions, and the Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD

^* Address reprint requests to Dr. Watkins, The Johns Hopkins Hospital, Baltimore, MD 21205

Myocardial revascularization and implantation of the automatic implantable cardioverter defibrillator (AICD) have individually been shown to improve survival in patients after sudden cardiac death. Their combined role has not been well defined.

Twenty-three survivors of sudden death underwent revascularization and AICD implantation at an average age of 59 years. The initial arrest was caused by ventricular fibrillation in 15 and ventricular tachycardia in 8. Exercise stress tests, ambulatory ECGs, and electrophysiological monitoring with programmed electrical stimulation were done preoperatively and postoperatively.

Follow-up averaged 24 months with a two-year survival of 91%. Eight patients (35%) required AICD resuscitation an average of 8 months postoperatively, and electrophysiological testing did not accurately predict arrhythmia recurrence. The addition of AICD implantation to revascularization substantially improves survival of patients with sudden cardiac death.

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