Patient selection for ICD treatment and peri-operative mortality

In view of the reported high risks resulting from the implantation of a cardioverter (ICD) and our own experience, we retrospectively evaluated the patients who received an ICD at our institution, so as to predict factors that could lead to a high peri-operative risk. The patients were divided into three groups according to their diagnoses and the surgical procedure. Group I: 10 patients with non-ischaemic cardiomyopathy, age 53.9 +/- 14.0 years, ejection fraction (EF) 33.1 +/- 11.8; group II:13 patients with coronary artery disease (CAD), diffuse arteriosclerosis, age 60.0 +/- 6.8 years, EF 31.4 +/- 9.1%; group III:12 patients, age 61.9 +/- 9.4 years, EF 41.2 +/- 8.6, CAD, concomitant bypass grafting. In cases of cardiomyopathy, cardiac complications (30%) were reversible by adequate drug therapy. However, five patients in group II (38.5%) died from cardiac complications, mainly frequent arrhythmias and subsequent pump failure. In group III no peri-operative complications occurred. Therefore the high mortality (overall 13.2%) in our series was exclusively due to patients suffering from severe CAD and unsuitable for revascularization. Considering the high risk after ICD placement, primary heart transplantation might be the better procedure in younger patients with end-stage CAD.