Electrophysiology-guided defibrillator implantation early after ST-elevation myocardial infarction

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Saurabh KumarPramesh Kovoor

Abstract

Sudden death risk is highest early after myocardial infarction (MI). Inducible ventricular tachycardia (VT) confers increased risk of spontaneous ventricular arrhythmias. The purpose of this study was to evaluate outcomes of electrophysiology (EP)-guided defibrillator implantation early after ST-elevation MI in patients with ejection fraction ≤40%. EP study was performed 9 days after MI (n = 360). Predischarge defibrillator was recommended if VT with cycle length ≥200 ms was induced with ≤4 extrastimuli (EP-positive [EP(pos)], n = 142). EP-negative (EP(neg)) patients were discharged without a defibrillator (n = 218). Primary endpoint was either sudden death or spontaneous ventricular arrhythmia. Defibrillator was implanted in 71% of EP(pos) patients (median 21 days post-MI) and withheld in 94% of EP(neg) patients. At 2 years, primary endpoint was 4.3% in the EP(neg) group and 22% in the EP(pos) group (adjusted hazard ratio 0.46, P = .035, EP(neg) vs EP(pos)). Lack of a defibrillator in EP(pos) patients conferred a fourfold increased risk of sudden death (P = .014). EP(neg) patients without a defibrillator were at significantly lower risk for the primary endpoint than were EP(pos) patients without a defibrillator (adjusted HR 0....Continue Reading

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Citations

Jun 26, 2012·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Sarah ZamanPramesh Kovoor
Oct 26, 2013·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Chrishan J NalliahPramesh Kovoor
Mar 7, 2014·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Sarah ZamanPramesh Kovoor
Oct 1, 2014·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Sarah ZamanPramesh Kovoor
Mar 20, 2012·Current Cardiology Reports·Nawaf S Al-Majed, Justin A Ezekowitz
Aug 25, 2015·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Gregory Y H LipIrene Savelieva
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Apr 25, 2012·Heart, Lung & Circulation·Susan J Corcoran, Lloyd M Davis
Jan 12, 2011·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Andrea M Russo
Nov 3, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Raja Selvaraj, Krishnakumar Nair
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Aug 21, 2016·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Mark E Josephson
Sep 13, 2016·Heart, Lung & Circulation·Ashleigh DindRavinay Bhindi
Oct 22, 2013·Circulation. Arrhythmia and Electrophysiology·Calvin H C HsiehPramesh Kovoor
Sep 17, 2013·Circulation. Arrhythmia and Electrophysiology·Calvin H C HsiehPramesh Kovoor

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