Electrophysiology Guided Defibrillator Implantation Early After ST Elevation Myocardial Infarction.
Summary of "Electrophysiology Guided Defibrillator Implantation Early After ST Elevation Myocardial Infarction."
BACKGROUND:
: Sudden death risk is highest early post myocardial infarction. Inducible ventricular tachycardia (VT) confers increased risk of spontaneous ventricular arrhythmias.
OBJECTIVES:
: To evaluate outcomes of electrophysiology (EP) guided defibrillator implantation early after ST elevation myocardial infarction (MI) in patients with ejection fraction METHODS:
: EP study performed at 9 days post MI (n=360). Pre-discharge defibrillator recommended if VT >/= 200 ms cycle length induced with RESULTS:
: Defibrillator implanted in 71% of EP(pos) (median 21 d post MI) and withheld in 94% of EP(neg) patients. At 2 years, primary endpoint was 4.3% in EP (neg) and 22% in EP(pos) group (adjusted hazard ratio [HR] 0.46, p=0.035, EP(neg) vs. EP(pos)). Lack of a defibrillator in EP(pos) patients conferred a 4 fold increase risk of sudden death (P=.014). EP(neg) patients without a defibrillator were at significantly lower risk of primary endpoint than EP(pos) patients without a defibrillator (adjusted HR 0.34, P=0.011). Short inducible VT cycle length (200-230 ms) and use of the 4(th) extra-stimulus identified patients at significant arrhythmic risk.
CONCLUSIONS:
: An EP study performed early after MI identified patients at significant long term arrhythmic risk at a critical time post MI in whom defibrillator implantation was protective. A large majority of patients (EP negative; 2/3(rd)) were at significantly lower risk of arrhythmic events without a defibrillator in the long term.
Affiliation
Department of Cardiology, Westmead Hospital, Sydney, Australia.
Journal Details
This article was published in the following journal.
Name: Heart rhythm : the official journal of the Heart Rhythm Society
ISSN: 1556-3871
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20650333
- DOI: http://dx.doi.org/10.1016/j.hrthm.2010.07.019
Medical and Biotech [MESH] Definitions
Prosthesis-related Infections
Infections resulting from the implantation of prosthetic devices. The infections may be acquired from intraoperative contamination (early) or hematogenously acquired from other sites (late).
Anterior Wall Myocardial Infarction
MYOCARDIAL INFARCTION in which the anterior wall of the heart is involved. Anterior wall myocardial infarction is often caused by occlusion of the left anterior descending coronary artery. It can be categorized as anteroseptal or anterolateral wall myocardial infarction.
Embryo Implantation
Endometrial implantation of EMBRYO, MAMMALIAN at the BLASTOCYST stage.
Embryo Implantation, Delayed
Delay in the attachment and implantation of BLASTOCYST to the uterine ENDOMETRIUM. The blastocyst remains unattached beyond the normal duration thus delaying embryonic development.
Cardiac Electrophysiology
The study of the electrical activity and characteristics of the HEART; MYOCARDIUM; and CARDIOMYOCYTES.
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