Coronary artery bypass grafting in the management of ventricular arrhythmias in patients with coronary artery disease

This review analyzes the role of coronary artery bypass grafting in ventricular arrhythmia associated with exertion, problematic sustained ventricular tachycardia, and sudden cardiac death associated with documented ventricular arrhythmia, or first manifestation of coronary artery disease. Specifically discussed is the role of acute ischemia in initiating and perpetuating ventricular arrhythmia. Coronary artery bypass grafting is indicated as a curative intervention for ventricular arrhythmia, but in only one rare instance: exercise-induced ischemia associated with problematic sustained ventricular arrhythmia, when the tachycardia is documented as being induced by acute ischemia. In other instances, indications for coronary artery bypass grafting follow the current guidelines based on clinical trials. Patients with the most severely damaged coronary artery anatomy associated with impaired left ventricular dysfunction have their life expectancy significantly prolonged after coronary artery bypass grafting. These results have been presented as evidence that coronary artery bypass grafting prevents ventricular arrhythmia and sudden cardiac death by modifying the two most powerful predicting factors of sudden cardiac death: coronary artery anatomy and left ventricular function.