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Implantable Cardioverter-Defibrillators Improve Survival after Coronary Artery Bypass Grafting in Patients with Impaired Left Ventricular Function
A. S. Al-Dadah, P. Rahgozar, A. Zierer, J. S. Lawton, M. R. Moon, M. K. Pasque, R. J. Damiano, N. Moazami. Department of Surgery, Division of Cardiothoracic Surgery at Washington University School of Medicine, St Louis, MO,
Objective: Patients with severe left ventricular (LV) dysfunction have a poor long term survival despite complete surgical revascularization. Recent data suggests that the use of Implantable Cardioverter-Defibrillator (ICD) improves survival in patients with severe LV dysfunction. We compared the survival impact of ICD implantation post-operatively in patients with severe LV dysfunction who underwent CABG.
Methods: Between January 1996 and August 2004, 305 patients with LV ejection fraction (LVEF) ≤ 25% had CABG at our institution. Demographics of patients who had received an ICD (+ICD) in the post -operative period were compared to those without ICD (-ICD). Survival was evaluated by the Kaplan-Meier method.
Results: Of the entire group, 35(11%) patients received an ICD with a median of 2(±2) years after CABG for clinical evidence of non sustained ventricular tachycardia (NSVT). There were no differences between the 2 groups with respect to more than 70 variables analyzed. Survival at 1, 3 and 5 years was 88%, 79%, and 67% for the -ICD group compared to 94%, 89% and 83% for the +ICD group, respectively (figure, p<0.05).
Conclusion: Implantation of ICD after CABG confers improved short and long term survival benefit to patients with severe LV dysfunction and symptomatic NSVT. The role of early or concomitant ICD implantation in the setting of severe LV dysfunction and CABG surgery should be revisited. 
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