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J Thorac Cardiovasc Surg 2007;133:289-291
© 2007 The American Association for Thoracic Surgery

Editorial

Incidence of ventricular arrhythmias after left ventricular reconstructive surgery

^a Centre Cardiothoracique de Monaco, Monaco
^b San Donato Hospital, Milan, Italy
^c Department of Critical Care Medicine, University of Florence, Florence, Italy.

Received for publication July 13, 2006; accepted for publication August 7, 2006.

^_* Address for reprints: Marisa Di Donato, MD, Department of Critical Care Medicine, University of Florence, Via dei Fossi 12, Florence 50123, Italy. (Email: marad@tin.it).

The first 300 words of the full text of this article appear below.

A recent article from O’Neill and coworkers¹ published in the Journal in November 2005 reports that after left ventricular reconstruction (LVR) for ischemic cardiomyopathy, either akinetic or dyskinetic, patients might remain at risk for malignant ventricular arrhythmias and hence might benefit from a prophylactic implantable cardioverter defibrillator (ICD). There are no clear guidelines regarding the necessity of early ICD implantation in patients undergoing LVR because the most important trials addressing this issue excluded patients within 3 months (Madit II) after coronary artery bypass grafting surgery.²

The authors report a high residual incidence of inducible ventricular tachycardia (VT) after surgical intervention (42%), and they conclude that either early ICD implantation or predischarge electrophysiologic (EP) study for risk stratification is indicated in patients submitted to LVR for ischemic dilated cardiomyopathy.

Major limitations of that study are that (1) ventricular volumes are not measured before and after, and (2) the EP study is performed only after surgical intervention, and this negates the possibility of evaluating the effects of LVR on arrhythmias.

The authors look at 217 patients who had LVR and divide them into 3 groups. Groups 1 and 2 had an ICD implanted either before or after surgical intervention. Thirty patients had ICDs in situ before the operation (group 1), and 74 patients had ICD implantation after LVR (group 2); indications for postoperative ICD implantation were secondary prevention in 28 and primary prevention in 48 (positive EP study result). The authors then compare these 2 groups with another group of 116 patients who did not receive an ICD. Of these, 67 had EP studies (negative results in 65), and 46 did not undergo EP studies for some reason.

Patients in group 1 are the sickest because they have the largest volumes, more frequent need of concomitant mitral valve surgery, and the lowest . . . [Full Text of this Article]

Related Article

Reply to Di Donato and colleagues

James O. O’Neill, Randall C. Starling, and Mina K. Chung
J. Thorac. Cardiovasc. Surg. 2007 133: 292-293. [Extract] [Full Text] [PDF]

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