Management of atrial fibrillation in patients with implantable cardioverter defibrillator. Do all need a dual chamber device?

plete revascularization could be achieved. Thus, it is very encouraging that, in the stent era, even in diabetics with multivessel disease after CABG, PCI may be contemplated as a reasonable treatment option when additional revascularization is required. The disturbing news is that overall, diabetics continue to fare much worse than non diabetics, with large increases in mortality at 3 years. The magnitude of this increased risk appears similar in patients with vs without prior CABG. This worse outcome of PCI in diabetics is related to the more frequent multivessel disease, to the possibility of accelerated atherogenesis or plaque progression in the vessels subjected to revascularization, even at non target sites, and to the greater difficulty to achieve complete revascularization in diabetics. Previous studies have highlighted the specificity of atherothrombosis in diabetic patients and also suggested the increased propensity for plaque progression and restenosis in these patients. From the interventionalist point of view, drugeluting stents represent our best hope to improve the outcome of PCI in diabetics, especially in the very severe subset of patients who have undergone prior CABG, in whom complete revascularization appears so critical. This provides another reason to eagerly await the results of ongoing trials testing drug-eluting stents in diabetic patients. P. G. STEG L. J. FELDMAN Service de Cardiologie, Hôpital Bichat, Paris, France