An Implantable Cardioverter-Defibrillator Rescued a Patient from Potentially Lethal Arrhythmias after Partial Left Ventriculectomy

Shogo Mukai* Yasushi Kawaue** Taijiro Sueda***

(Department of Cardiovascular Surgery, National Hospital Kure Medical Center*, Hiroshima, Japan, Department of Cardiovascular Surgery, Hiroshima General Hospital**, Hiroshima, Japan and The First Department of Surgery, Hiroshima University School of Medicine***, Hiroshima, Japan)

A 36-year-old man underwent partial left ventriculectomy (PLV) to treat end-stage dilated hypertrophic cardiomyopathy. Mitral valve replacement and tricuspid valve annuloplasty were performed to correct the mitral and tricuspid valve insufficiency. The patient suffered ventricular tachycardia and ventricular fibrillation (VT/VF) soon after surgery, but antiarrhythmic-drug therapy was sufficiently effective to treat the VT/VF. On the third postoperative day, an implantable cardioverter-defibrillator (ICD) was implanted to prevent these arrhythmias. Two months later after his discharge from the hospital, recurrent VT/VF appeared and was supposedly associated with renal failure. Continuous hemodialysis was efficacious to ameliorate the systemic circulation, and ventricular arrhythmias disappeared. He survived due to 18 ICD shocks. In appropriately selected patients, ICDs have been recognized as one of the cost-effective therapeutic options. ICDs might be recommended for patients in the postoperative period of PLV who have potentially lethal ventricular arrhythmias resistant to antiarrhythmic-drug therapy.   
 Jpn. J. Cardiovasc. Surg. 31: 205-208(2002)