Ann Thorac Surg 1988;46:13-19
© 1988 The Society of Thoracic Surgeons
Articles
Impending Sudden Cardiac Death: Treatment with Myocardial Revascularization and the Automatic Implantable Cardioverter Defibrillator
James D. Fonger, M.D.,
Thomas Guarnieri, M.D.,
Lawrence S.C. Griffith, M.D.,
Enrico Veltri, M.D.,
Joseph Levine, M.D.,
Morton Mower, M.D.,
M. Mirowski, M.D.,
Louise Grunwald, B.A.,
Levi Watkins, Jr., M.D.*
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
 |
Abstract
|
|---|
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.
|
Footnotes
|
|---|
Presented at the Twenty-third Annual Meeting of The Society of Thoracic Surgeons, Toronto, Ont, Canada, Sept 21–23, 1987.
|
References
|
|---|
- Lown B. Sudden cardiac death: the major challenge confronting contemporary cardiology Am J Cardiol 1979;43:313.[Medline]
- Holmes Jr DR, Davis KB, Mock MB, et al. The effect of medical and surgical treatment on subsequent cardiac death in patients with coronary artery disease: a report from the Coronary Artery Surgery Study Circulation 1986;73:1254.[Abstract/Free Full Text]
- Tresch DD, Wetherbee JN, Siegel R, et al. Long-term follow-up of survivors of prehospital sudden cardiac death treated with coronary bypass surgery Am Heart J 1986;110:1139.
- Garan H, Ruskin JN, DiMarco JP, et al. Electrophysiologic studies before and after myocardial revascularization in patients with life-threatening ventricular arrhythmias Am J Cardiol 1983;51:519.[Medline]
- Echt DS, Armstrong K, Schmidt P, et al. Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator Circulation 1985;71:289.[Abstract/Free Full Text]
- Watkins Jr L, Mower MM, Reid PR, et al. Trials of the automatic implantable defibrillator in man J Thorac Cardiovasc Surg 1983;86:381.[Abstract]
- Cobb LA, Baum RS, Alvarez III H, Schaffer WA. Resuscitation from out-of-hospital ventricular fibrillation: 4 years' follow-up Circulation 1975;52(Suppl 3):22351.
- Myerburg RJ, Kessler KM. Management of patients who survive cardiac arrest Mod Concepts Cardiovasc Dis 1986;51:61.
- Graboys TB, Lown B, Podrid PJ, DeSilva R. Long-term survival of patients with malignant ventricular arrhythmia treated with antiarrhythmic drugs Am J Cardiol 1982;50:437.[Medline]
- Mirowski M, Reid PR, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings N Engl J Med 1980;303:322.[Medline]
- Reid PR, Mirowski M, Mower MM, et al. Clinical evaluation of the internal automatic cardioverter-defibrillator in survivors of sudden cardiac death Am J Cardiol 1983;51:1608.[Medline]
- Horowitz LN, Harken AH, Kastor JA, Josephson ME. Ventricular resection guided by epicardial and endocardial mapping for treatment of recurrent ventricular tachycardia N Engl J Med 1980;302:589.[Medline]
- Josephson ME, Harken AH, Horowitz LN. Long-term results of endocardial resection for sustained ventricular tachycardia in coronary disease patients Am Heart J 1982;104:51.[Medline]
- Mason JW, Stinson EB, Winkle RA, et al. Surgery for ventricular tachycardia: efficacy of left ventricular aneurysm resection compared with operation guided by electrical activation mapping Circulation 1982;65:1148.[Abstract/Free Full Text]
This article has been cited by other articles:
|
|
|
|
 
J. J. Morris, A. Rastogi, M. S. Stanton, B. J. Gersh, S. C. Hammill, and H. V. Schaff
Operation for ventricular tachyarrhythmias: Refining current treatment strategies
Ann. Thorac. Surg.,
November 1, 1994;
58(5):
1490 - 1498.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E. E. Vyhmeister, A. J. Razzouk, G. S. Van Arsdell, V. I. Torres, S. R. Gundry, and L. L. Bailey
Simple approach for extrapericardial placement of defibrillator patches via median sternotomy
Ann. Thorac. Surg.,
May 1, 1994;
57(5):
1341 - 1342.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. A. Elefteriades, L. A. Biblo, W. P. Batsford, L. E. Rosenfeld, R. W. Henthorn, M. D. Carlson, A. L. Waldo, J. Hsu, and A. S. Geha
Evolving patterns in the surgical treatment of malignant ventricular tachyarrhythmias
Ann. Thorac. Surg.,
January 1, 1990;
49(1):
94 - 100.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. Watkins Jr
Treatment of impending sudden cardiac death
Ann. Thorac. Surg.,
March 1, 1989;
47(3):
484 - 485.
[PDF]
|
|
|
Top
Abstract
Footnotes
