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

Sunil Nath, David E. Haines, William A. DeLacey, Virginia A. Berry, Michael J. Barber, Irving L. Kron, John P. DiMarco

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)652-657
Number of pages6
JournalThe American Journal of Cardiology
Volume72
Issue number9
DOIs
StatePublished - Sep 15 1993
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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