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Background  Randomized studies of implantable cardioverter defibrillators ( ICD ) have excluded sudden cardiac death survivors who had revascularization  before  or  after  an arrhythmic event. To evaluate the role of  ICD  and the effects of clinical variables including degree of revascularization, we studied cardiac surgery patients who had an  ICD  implanted for sustained perioperative ventricular arrhythmias.    Methods and Results  The electronic database for Southern California Kaiser Foundation hospitals was searched for patients who had cardiac surgery between 1999 and 2005 and an  ICD  implanted within 3 months of surgery. One hundred sixty‐four patients were identified; 93/164 had an  ICD  for sustained pre‐ or postoperative ventricular tachycardia or fibrillation requiring resuscitation. Records were reviewed for the following: presenting arrhythmia, ejection fraction, and degree of revascularization. The primary end point was total mortality ( TM ) and/or appropriate  ICD  therapy ( ICD ‐T), and secondary end points are  TM  and  ICD ‐T. During the mean follow up of 49 months, the primary endpoint of  TM + ICD ‐T and individual end points of  TM  and  ICD ‐T were observed in 52 (56%), 35 (38%), and 28 (30%) patients, respectively, with 55% of  TM , and 23% of  ICD ‐T occurring within 2 years of implant. In multivariate risk analysis, none of the following was associated with any of the end points: incomplete revascularization, presenting ventricular arrhythmia, and timing of arrhythmias.    Conclusion  Our data supports the recent guidelines for  ICD  in this cohort of patients, as the presence of irreversible substrate and triggers of ventricular arrhythmias, cannot be reliably excluded even with complete revascularization. Further studies are needed to understand this complex group of patients.

Implantable Defibrillators for Secondary Prevention of Sudden Cardiac Death in Cardiac Surgery Patients With Perioperative Ventricular Arrhythmias