Post-infarction Patients with Left Ventricular Ejection Fraction of 30%-40%, Non-sustained Ventricular Tachycardia, and without Inducible Tachyarrhythmias: Is ICD Therapy Necessary?
Several important trials in the last few years have evaluated the use of the implantable cardioverter-defibrillator (ICD) in patients considered at high risk of sudden death [1–5]. There is little doubt that the ICD is the only approach currently available that is able to reduce the incidence of sudden unexpected arrhythmic death in patients who have survived a myocardial infarction and have a significantly reduced left ventricular (LV) function. Studies such as AVID , Muticenter Automatic Defibrillator Implantation Trial (MADIT) , and MADIT II  have demonstrated that patients with a very low LV ejection fraction (LV-EF, less than 26%) benefit most from the ICD. This, however, does not mean that patients with coronary artery disease with somewhat better-preserved LV function, i.e., LV-EF between 40% and 30%, have a low incidence of sudden arrhythmic death. More than 56% of patients with remote myocardial infarction who later die suddenly have a LV-EF greater than 30% . As stated recently by Buxton , it is necessary to identify potential victims of sudden death that can be saved by ICD treatment in this large reservoir of lower-risk post myocardial infarction patients. Since 85%–90% of sudden deaths occur with the first arrhythmic event , and only 10%–15% with recurrent arrhythmic episodes, the role of primary prevention of sudden death becomes evenmore important.
KeywordsArrhythmic Event Sustained Ventricular Tachycardia Arrhythmic Death Multicenter Automatic Defibrillator Implantation Trial Heart Rate Turbulence
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