Implantable Defibrillator Use for De Novo Ventricular Tachyarrhythmias Encountered After Cardiac Surgery

TELFER, E.A., et al.: Implantable Defibrillator Use for De Novo Ventricular Tachyarrhythmias Encountered After Cardiac Surgery. De novo postoperative life-threatening ventricular arrhythmias are poorly understood. Long-term benefits of, and need for, treatment is uncertain. To assess the therapeutic advantage of ICD to manage new-onset, life-threatening ventricular tachyarrhythmias after cardiac surgery. Patients included were those with an ICD implanted for de novo life-threatening ventricular tachyarrhythmias encountered 48 hours or more after cardiac surgery. Primary endpoints were total survival, time to first ICD therapy, and appropriateness of ICD therapy. Mean projected survival and projected time to first ICD therapy were calculated by the Kaplan-Meier method. Twenty-seven postoperative patients (left ventricular ejection fraction 0.22 ± 0.07) were followed for 26 ± 17.6 months. The index arrhythmia was sustained monomorphic ventricular tachycardia in 17 (63%) and ventricular fibrillation in 10 (37%). Electrophysiological study was positive in 22 (81%) of 27. Total survival and mean projected survival after ICD implant were 22 (81%) of 27 and 25.6 months, respectively, to end of follow-up. The majority received ICD therapy (21/27 [78%]), 20 (74%) of 27 receiving appropriate therapy. The mean time to first ICD therapy and mean projected time to first ICD therapy was 5.6 ± 7.8 months and 10.5 months, respectively. De novo postoperative ventricular arrhythmias are associated with a high probability of late recurrence. The ICD is useful for these patients.