TY - JOUR
T1 - ICD implantation for secondary prevention in patients with ventricular arrhythmia in the setting of acute cardiac ischemia and a history of myocardial infarction
AU - van Dijk, Vincent F.
AU - Quast, Anne-Floor B. E.
AU - Schaap, Jeroen
AU - Balt, Jippe C.
AU - Kelder, J. C.
AU - Wijffels, Maurits C. E. F.
AU - de Groot, Joris R.
AU - Boersma, Lucas V. A.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Introduction: In patients with a prior myocardial infarction (MI) but preserved left ventricular (LV) function, sustained ventricular arrhythmias (VAs) may arise in the setting of an acute coronary syndrome (ACS). It is unknown whether an implantable cardioverter-defibrillator (ICD) is mandatory in these patients as VA might be triggered by a reversible cause. The purpose of this study is to analyze the benefit of ICD therapy in this patient population. Methods: We conducted a retrospective observational study in ICD recipients implanted from 2008 to 2011. The study group consisted of patients with sustained VA in the setting of an ACS, with a history of MI, but with left ventricular ejection fraction (LVEF) greater than 35 (group A). The two control groups consisted of patients admitted with VA with a history of MI, but without ACS at presentation, either with LVEF greater than 35% (group B) or ≤35% (group C). The primary endpoint was the number of patients with appropriate ICD therapy (antitachycardia pacing or shock). Results: A total of 291 patients were included with a mean follow-up of 5.3 years. Appropriate ICD therapy occurred in 45.6% of the patients in group A vs 51.6% and 60.4% in groups B and C (P =.11). In group A, 31.1% received an appropriate ICD shock vs 34.7% and 44.3% in control groups B and C (P =.12). Conclusion: On the basis of these data, ICD implantation seems warranted in patients with history of MI presenting with VA in the setting of an ACS, despite preserved LV function and adequate revascularization. Further trials, preferably randomizes, should be performed to address these findings.
AB - Introduction: In patients with a prior myocardial infarction (MI) but preserved left ventricular (LV) function, sustained ventricular arrhythmias (VAs) may arise in the setting of an acute coronary syndrome (ACS). It is unknown whether an implantable cardioverter-defibrillator (ICD) is mandatory in these patients as VA might be triggered by a reversible cause. The purpose of this study is to analyze the benefit of ICD therapy in this patient population. Methods: We conducted a retrospective observational study in ICD recipients implanted from 2008 to 2011. The study group consisted of patients with sustained VA in the setting of an ACS, with a history of MI, but with left ventricular ejection fraction (LVEF) greater than 35 (group A). The two control groups consisted of patients admitted with VA with a history of MI, but without ACS at presentation, either with LVEF greater than 35% (group B) or ≤35% (group C). The primary endpoint was the number of patients with appropriate ICD therapy (antitachycardia pacing or shock). Results: A total of 291 patients were included with a mean follow-up of 5.3 years. Appropriate ICD therapy occurred in 45.6% of the patients in group A vs 51.6% and 60.4% in groups B and C (P =.11). In group A, 31.1% received an appropriate ICD shock vs 34.7% and 44.3% in control groups B and C (P =.12). Conclusion: On the basis of these data, ICD implantation seems warranted in patients with history of MI presenting with VA in the setting of an ACS, despite preserved LV function and adequate revascularization. Further trials, preferably randomizes, should be performed to address these findings.
KW - ICD
KW - acute coronary syndrome
KW - secondary prevention
KW - ventricular arrhythmia
UR - http://www.scopus.com/inward/record.url?scp=85078752436&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jce.14357
DO - https://doi.org/10.1111/jce.14357
M3 - Article
C2 - 31944462
SN - 1045-3873
VL - 31
SP - 536
EP - 543
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 2
ER -