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. 2015 Dec;38(12):715-9.
doi: 10.1002/clc.22477. Epub 2015 Oct 7.

Natural History and Implantable Cardioverter-Defibrillator Implantation After Revascularization for Stable Coronary Artery Disease With Depressed Ejection Fraction

Geoffrey F Lewis  1 , Adam C Harless  1 , Lauren Vazquez  2 , Freddy M Abi-Samra  1 , Michael L Bernard  1 , Sammy Khatib  1 , Glenn M Polin  1 , Daniel P Morin  1   3
Affiliations

Natural History and Implantable Cardioverter-Defibrillator Implantation After Revascularization for Stable Coronary Artery Disease With Depressed Ejection Fraction

Geoffrey F Lewis et al. Clin Cardiol. 2015 Dec.

Abstract

Background: Following revascularization, most payors require 3 months of medical therapy, followed by left ventricular ejection fraction (LVEF) reassessment, before implantable cardioverter-defibrillator (ICD) implantation possibly contributing to incomplete follow-up and suboptimal utilization of ICD therapy. The natural history of these patients, and their fate regarding ICD implantation, is unknown.

Hypothesis: We hypothesized that a waiting period after revascularization for stable CAD results in missed opportunities to provide care with regard to ICD implantation.

Methods: We followed patients with LVEF ≤ 35% and no ICD who underwent revascularization (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]) for stable CAD. Follow-up used chart review and scripted telephone interviews.

Results: Among 3164 revascularized patients (2198 [69%] PCI, 966 [31%] CABG), only 62 (2%; 33 [53%] male, age 67 ± 12 y, LVEF 28% ± 6%) had stable CAD, depressed LVEF, and no ICD. Over 35 ± 19 months, 35 (56%) of these 62 patients were no longer candidates for ICD based on improved LVEF, 14 (23%) received an ICD, 5 (8%) declined ICD despite physician recommendation, 3 (5%) were not offered ICD despite continued eligibility, 2 (3%) died, 1 (2%) was not a candidate due to substance abuse, and 1 (2%) had ICD implantation temporarily deferred. Only 1 (2%) was lost to follow-up.

Conclusions: Following revascularization for stable CAD with depressed LVEF, ≥50% of patients' ventricular function improved enough to make ICD implantation unnecessary. A waiting period after revascularization prior to ICD implantation appears appropriate and does not significantly negatively impact follow-up or the rate of appropriate ICD implantation.

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Figures

Figure 1
Figure 1
ICD‐related status on follow‐up of patients who underwent revascularization for stable CAD and depressed LV systolic function. Abbreviations: CAD, coronary artery disease; EF, ejection fraction; ICD, implantable cardioverter‐defibrillator; LV, left ventricular.
See this image and copyright information in PMC

References

    1. Moss AJ, Zareba W, Hall WF, et al; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–883. - PubMed
    1. Bardy GH, Lee DL, Mark DB, et al; Sudden Cardiac Death in Heart Failure Trial (SCD‐HeFT) Investigators. Amiodarone or an implantable cardioverter‐defibrillator for congestive heart failure [published correction appears in N Engl J Med. 2005;352:2146]. N Engl J Med. 2005;352:225–237. - PubMed
    1. Bigger JT Jr, et al; Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. Prophylactic use of implanted cardioverter‐defibrillators in patients at high risk for ventricular arrhythmias after coronary artery bypass graft surgery. N Engl J Med. 1997;337:1569–1575. - PubMed
    1. Hohnloser SH, Kuck KH, Dorian P et al; DINAMIT Investigators. Prophylactic use of an implantable cardioverter‐defibrillator after acute myocardial infarction. N Engl J Med. 2004;351:2481–2488. - PubMed
    1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device‐based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013;61:e6–e75. - PubMed