Comparison of the usefulness of the implantable cardioverter-defibrillator and subendocardial resection in patients with sustained ventricular arrhythmias and poor regional wall motion associated with coronary artery disease

The implantable cardioverter-defibrillator (ICD) and subendocardial resection are effective forms of therapy for sustained ventricular arrhythmias associated with coronary artery disease in selected patients. The relative efficacy of these 2 treatments in equivalently matched patients is not known. A regional wall motion score has been shown to be a powerful predictor of long-term outcome after both ICD implantation and subendocardial resection. This study retrospectively analyzed the long-term outcome of patients with coronary artery disease and ventricular arrhythmias treated during the same period with an ICD (n = 53) or by subendocardial resection (n = 65). Treatment outcomes were compared in subgroups determined by preoperative regional wall motion scores of either ≤16 or >16%. The 3-year cardiac mortality of the 2 therapies was not significantly different among patients with a wall motion score of >16% (0% ICD vs 11% endocardial resection) or of ≤16% (41% ICD vs 35% endocardial resection). Similarly, the 3-year sudden cardiac death mortality was similar among patients with a score of >16% (0% for both ICD and endocardial resection) or of ≤16% (9% ICD vs 14% endocardial resection, p = NS). At 24 months after hospital discharge, the percentage of patients who were in New York Heart Association functional class I or II was similar among patients with a wall motion score of >16% (75% ICD vs 86% endocardial resection, p = NS) or with a wall motion score of ≤16% (26% ICD vs 45% endocardial resection, p = NS). Patients with coronary artery disease and ventricular arrhythmias when risk-stratified by a preoperative regional wall motion score have no significant differences in long-term outcome after treatment with an ICD or with subendocardial resection.