PMID- 21398652
OWN - NLM
STAT- MEDLINE
DCOM- 20111007
LR  - 20110610
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 12
IP  - 6
DP  - 2011 Jun
TI  - Do implantable cardioverter defibrillators improve survival in patients with 
      severe left ventricular systolic dysfunction after coronary artery bypass graft 
      surgery?
PG  - 1010-6
LID - 10.1510/icvts.2010.259465 [doi]
AB  - A best evidence topic in cardiac surgery was written according to a structured 
      protocol. The question addressed was whether implantable cardioverter 
      defibrillators (ICD) improve survival in patients with severe left ventricular 
      systolic dysfunction (LVSD) after coronary artery bypass graft (CABG) surgery. 
      ICDs are designed to terminate potentially fatal cardiac tachyarrhythmias. A 
      right ventricular lead is mandatory for detection, pacing and defibrillation 
      capabilities. Dual chamber ICDs have an additional right atrial lead and are used 
      for patients with conventional atrioventricular pacing indications. More 
      sophisticated, biventricular devices exist to provide cardiac resynchronisation 
      therapy (CRT) in addition to defibrillation (CRT-D). ICDs have been extensively 
      investigated in patients with LVSD post myocardial infarction and in patients 
      with non-ischaemic cardiomyopathy for both secondary prevention (history of 
      ventricular arrhythmias) and primary prevention (deemed high risk for ventricular 
      arrhythmias). This best evidence topic aims to review the evidence and its 
      applicability to patients post CABG. Nine hundred and sixteen papers were 
      identified using the search method outlined. Eight randomised controlled trials, 
      two meta-analyses, and one non-randomised trial, in addition to international 
      guidelines presented the best evidence to answer the clinical question. The 
      current evidence base and guidelines suggest that ICDs should be considered for 
      all patients with LVSD [ejection fraction (EF) </=30-40%] receiving optimal 
      pharmacological management, who are >/=40 days post MI [four weeks for National 
      Institute for Health and Clinical Excellence (NICE)] and in New York Heart 
      Association (NYHA) class I-III. UK NICE guidelines require in addition; 
      non-sustained ventricular tachycardia (NSVT) on a Holter monitor and inducible 
      ventricular tachycardia at electrophysiological study for EF between 30 and 35%; 
      or a QRS >120 ms if EF <30%. The North American guidelines recommend EF <30% as a 
      threshold for those with NYHA class I symptoms. The evidence is applicable to 
      patients post CABG, provided all the other criteria are met. European Society of 
      Cardiology (ESC) guidelines recommend waiting at least three months (consensus 
      opinion) after revascularisation prior to assessment for an ICD, to allow time 
      for potential recovery of ventricular function.
FAU - Fazal, Iftikhar A
AU  - Fazal IA
AD  - Department of Cardiology, Freeman Hospital, High Heaton, Newcastle Upon Tyne NE7 
      7DN, UK. iftikharfazal@doctors.org.uk
FAU - Bates, Matthew G D
AU  - Bates MG
FAU - Matthews, Iain G
AU  - Matthews IG
FAU - Turley, Andrew J
AU  - Turley AJ
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20110311
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arrhythmias, Cardiac/etiology/*prevention & control
MH  - Benchmarking
MH  - Coronary Artery Bypass/*adverse effects/mortality
MH  - *Defibrillators, Implantable
MH  - Electric Countershock/*instrumentation
MH  - Evidence-Based Medicine
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Practice Guidelines as Topic
MH  - Recovery of Function
MH  - Severity of Illness Index
MH  - Systole
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/etiology/mortality/physiopathology/*therapy
MH  - *Ventricular Function, Left
EDAT- 2011/03/15 06:00
MHDA- 2011/10/08 06:00
CRDT- 2011/03/15 06:00
PHST- 2011/03/15 06:00 [entrez]
PHST- 2011/03/15 06:00 [pubmed]
PHST- 2011/10/08 06:00 [medline]
AID - icvts.2010.259465 [pii]
AID - 10.1510/icvts.2010.259465 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2011 Jun;12(6):1010-6. doi: 
      10.1510/icvts.2010.259465. Epub 2011 Mar 11.