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Coronary Revascularization and Implantation of the Automatic Cardioverter/Defibrillator: Reliability of Immediate Intraoperative Testing
Author(s) -
Blakeman Bradford M.,
Pifarre Roque,
Scanlon Patrick J.,
Wilber David J.
Publication year - 1989
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.1989.12.p1.86
Subject(s) - medicine , cardioversion , defibrillation , cardiology , defibrillation threshold , coronary sinus , implantable cardioverter defibrillator , ventricular tachycardia , cardiopulmonary bypass , revascularization , sinus rhythm , anesthesia , myocardial infarction , atrial fibrillation
Concomitant coronary revascularization and implantation of the automatic cardioverter/defibrillator is an increasingly common procedure. To determine whether cardioversion/defibrillation thresholds measured after weaning patients from cardiopulmonary bypass are sufficint to justify immediate implantation of the pulse generator, we prospectively compared postpump values to those obtained 1 week later in five patients. R‐wave amplitudes during both sinus rhythm and ventricular tachycardia, lead impedance, defibrillation thresholds and cardioversion thresholds remained stable or improved from the postpump to the 1 week values. Five other patients had the generator implanted at the time of revascularization. Immediate postbypass cardioversion thresholds (mean 10 ± 8 joules) in theses ten patients did not significantly differ from those of 20 nonpump implantations (VT mean 7± joules; VF 15 ± 4 joules and defibrillation thresholds mean 17 ± 6 joules). These findings suggest that the residual effects of cardioplegia, core‐cooling and operative ischemia have no significant effects on intraoperative testing of implanted dfibrillators. This clinical experience supports the practice of immediate implantation of the pulse generator at the time of revascularization.