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Coronary artery bypass in patients with previously placed implantable defibrillators
B P Blakeman1, D Wilber, B Olshansky
1Loyola University Medical Ctr., Maywood, IL 60153.
Insights
Patients with implantable defibrillators needing coronary revascularization can undergo bypass surgery safely. This study shows successful revascularization without complications in patients with existing defibrillator systems.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Device Technology
Background:
- Implantable defibrillators (ICDs) are crucial for managing arrhythmias.
- Coronary revascularization is a common procedure for ischemic heart disease.
- The coexistence of ICDs and the need for coronary revascularization presents unique clinical challenges.
Observation:
- Four patients with pre-existing ICDs (three conventional, one nonthoracotomy) required coronary revascularization.
- The procedures were performed several years after ICD implantation.
- One patient with a nonthoracotomy system required separate endocardial lead manipulation.
Findings:
- All four patients underwent successful coronary revascularization.
- No perioperative myocardial infarction or significant morbidity was observed.
- The presence of an ICD did not preclude successful revascularization.
Implications:
- Coronary revascularization is feasible and safe in patients with implantable defibrillators.
- Careful planning and potential lead management are necessary for successful outcomes.
- This approach can improve the management of patients with both conditions.
Abstract:
Four patients with previously placed implantable defibrillators required coronary revascularization several years after the original device was inserted. Three patients had a conventional system of epicardial patches and leads, and one patient had a nonthoracotomy system placed. All four patients were successfully revascularized without evidence of perioperative infarction or significant morbidity. The patient with the nonthoracotomy device did require manipulation of the endocardial lead at a separate setting. This limited experience suggests that patients needing revascularization after placement of an implantable defibrillator can be successfully bypassed.