An Assessment of Time Dependence of Defibrillator Benefit After Coronary Revascularization

Background: Previous studies have suggested that the benefit of implantable cardioverter defibrillator (ICD) implantation in patients following coronary revascularization (CR) may be related to time elapsed since revascularization, with those receiving the device > 6 months after the procedure deriving the greatest benefit. Methods: We evaluated 163 patients (141 M/22 F, age 67 ± 11 y, LVEF 30 ± 8%) with a history of CR who underwent electrophysiology study (EPS) for risk stratification. ICD implantation was at the discretion of the treating physician. Oc- currence of arrhythmia in ICD patients was ascertained from regular device clinic follow-up. Vital status was assessed us- ing the National Death Index. Results: 101 patients (62%) had recent CR (� 6 months before EPS) vs 62 (38%) with remote CR (> 6 months). Median follow-up was 29 ± 17 months. There was no difference in arrhythmia-free survival (p = 0.89, 84 (83%) vs 52 (84%) at 12 months), time to appropriate ICD therapy (p = 0.35, 94 (93%) vs 55 (89%) at 12 months), or overall survival (p = 0.15, 91 (90%) vs 59 (95%) at 12 months) between recent and remote CR patients. Conclusions: Overall survival, arrhythmia-free survival, and time to first appropriate ICD therapy are similar between pa- tients with recent and remote CR undergoing an EPS-guided approach to risk stratification.