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J Thorac Cardiovasc Surg 2006;131:1211
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine/F15, 9500 Euclid Ave, Cleveland, OH 44195

As stated in the article, 30 patients had implantable cardiovertor-defibrillators inserted preoperatively, and the indication for the majority of these patients was secondary prevention, having had either a documented ventricular arrhythmia or aborted sudden death. Of these 30 patients, 2 had aborted sudden cardiac death, 3 had sustained ventricular tachycardia, and the remainder presumably had positive electrophysiologic (EP) studies. For groups 2 and 3 of our series, we do not have accurate data on who underwent EP studies preoperatively.

Dr Sartipy's group performs EP studies preoperatively. This approach is used to guide endocardial resection or cryoablation. Many of our patients (13%) underwent cryoablation for arrhythmias. However, the main indication for left ventricular reconstruction (LVR) was heart failure, rather than intractable arrhythmias.

LVR definitely has a role in the treatment of ventricular arrhythmias, but in patients with severe left ventricular dysfunction, border zones between scar and viable myocardium might provide arrhythmic substrate. In addition, patients in our series had evidence of marked left ventricular remodelling, with arrhythmic substrate in areas remote to the site of LVR.

Against that, the Coronary Artery Bypass Graft Patch Trial ¹ failed to show a reduction in mortality when patients with markers for increased risk of ventricular arrhythmia underwent implantable cardioverter-defibrillator implantation at the time of coronary artery bypass grafting. This has been attributed to a reduction in the risk of arrhythmic death as a result of revascularization. ² This indicates that perhaps the most important procedure to reduce arrhythmias is surgical revascularization.

Further prospective studies are required to elucidate the optimal strategy in this complex group of patients.

	References

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1. Bigger Jr JT, Coronary Artery Bypass Graft (CABG) Patch Trial Investigators Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. N Engl J Med 1997;337:1569-1575.[Abstract/Free Full Text]
   
2. Veenhuyzen GD, Singh SN, McAreavey D, Shelton BJ, Exner DV. Prior coronary artery bypass surgery and risk of death among patients with ischemic left ventricular dysfunction. Circulation 2001;104:1489-1493.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chung, M. K. Articles by O'Neill, J. O. Search for Related Content PubMed Articles by Chung, M. K. Articles by O'Neill, J. O. Related Collections Congestive Heart Failure Coronary disease Electrophysiology - arrhythmias Myocardial infarction Related Article