ICD Implantation for Secondary Prevention in Patients with Ventricular Arrhythmia in the Setting of Acute Cardiac Ischemia and a History of Myocardial Infarction

INTRODUCTION:

In patients with a prior myocardial infarction (MI) but preserved LV function, sustained ventricular arrhythmias (VA) 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 analyse 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 LVEF>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 >35% (group B) or ≤35% (group C). The primary endpoint was the number of patients with appropriate ICD therapy (anti tachycardia pacing or shock).

RESULTS:

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 versus 51.6% and 60.4% in groups B and C (p=0.11). In group A 31.1% received an appropriate ICD shock versus 34.7% and 44.3% in control groups B and C(p=0,12).

CONCLUSION:

Based on 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.