Post-infarction Patients with Left Ventricular Ejection Fraction of 30%-40%, Non-sustained Ventricular Tachycardia, and without Inducible Tachyarrhythmias: Is ICD Therapy Necessary?

  • H. U. Klein
  • S. Reek
  • C. Geller
  • A. Auricchio
Conference paper


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 [1], Muticenter Automatic Defibrillator Implantation Trial (MADIT) [3], and MADIT II [5] 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% [6]. As stated recently by Buxton [7], 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 [8], and only 10%–15% with recurrent arrhythmic episodes, the role of primary prevention of sudden death becomes evenmore important.


Arrhythmic Event Sustained Ventricular Tachycardia Arrhythmic Death Multicenter Automatic Defibrillator Implantation Trial Heart Rate Turbulence 
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  1. 1.
    AVID Investigators (1997) A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 337:1576–1583CrossRefGoogle Scholar
  2. 2.
    Kuck K-H, Cappato R, Siebels J, Rüppel R (2000) CASH investigators. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: The Cardiac Arrest Study Hamburg (CASH). Circulation 102:748–754PubMedCrossRefGoogle Scholar
  3. 3.
    Moss AJ, Hall WJ, Cannom DS et al (1996) Improved survival with an implanted defi-brillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter automatic defibrillator implantation trial investigators. N Engl J Med 335:1933–1940PubMedCrossRefGoogle Scholar
  4. 4.
    Buxton AE, Lee KL, Fisher JD et al (1999) A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 341:1882–1890PubMedCrossRefGoogle Scholar
  5. 5.
    Moss AJ, Zareba W, Hall WJ et al, for the Multicenter Automatic Defibrillator Implantation Trial II Investigators (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883PubMedCrossRefGoogle Scholar
  6. 6.
    Vreede-Swagemakers JJ de, Gorgels AP, Dubois-Arbouw WI et al (1997) Out-of-hospi-tal cardiac arrest in the 1990’s: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol 30:1500–1505PubMedCrossRefGoogle Scholar
  7. 7.
    Buxton AE (2003) The clinical use of implantable cardioverter defibrillators: where are we now? Where should we go (editorial). Ann Intern Med 138:512–514PubMedGoogle Scholar
  8. 8.
    Myerburg RJ (2002) Scientific gaps in the prediction and prevention of sudden cardiac death. J Cardiovasc Electrophysiol 13:709–723PubMedCrossRefGoogle Scholar
  9. 9.
    Wilber DJ, Olshansky B, Moran JF, Scanion PJ (1990) Electrophysiological testing and nonsustained ventricular tachycardia: use and limitation in patients with coronary artery disease and impaired ventricular function. Circulation 82:350–358PubMedCrossRefGoogle Scholar
  10. 10.
    Buxton AE, Lee KL, Di Carlo L et al (2002) Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. Multicenter Unsustained Tachycardia Trial investigators. N Engl J Med 342:1937–1945CrossRefGoogle Scholar
  11. 11.
    Daubert JP, Higgins SL, Zareba W, Wilber DJ (1997) Comparative survival of MADIT-eligible but noninducible patients (abstract). J Am Coll Cardiol 25:78AGoogle Scholar
  12. 12.
    Moss AJ, Fadl Y, Zareba W, Cannom DS, Hall WJ (2001) Survival benefit with an implanted defibrillator in relation to mortality risk in chronic coronary heart disease. AmJCardiol 88:516–520CrossRefGoogle Scholar
  13. 13.
    Moss AJ (2000) Implantable cardioverter defibrillator therapy. The sickest patients benefit the most. Circulation 101:1638–1640PubMedCrossRefGoogle Scholar
  14. 14.
    Daubert JP, Zareba W, Schuger CD et al (2003) Does EPS inducibility in MADIT II patients predict subsequent VT and/or VF events? (abstract). Pacing Clin Electrophysiol 26:960Google Scholar
  15. 15.
    Reek S, Klein HU, Neumann T et al (2003) Reproducibility of electrophysiologic testing in patients with remote myocardial infarction and severe left ventricular dysfunction: MADIT II Substudy (abstract). Pacing Clin Electrophysiol 26:960Google Scholar
  16. 16.
    Buxton AE, Lee KL, Hafley GE et al (2002) Relation of ejection fraction and inducible ventricular tachycardia to mode of death in patients with coronary artery disease. Circulation 106:2466–2472PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • H. U. Klein
    • 1
  • S. Reek
    • 1
  • C. Geller
    • 1
  • A. Auricchio
    • 1
  1. 1.University Hospital MagdeburgDivision of CardiologyMagdeburgGermany

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