Key result
Early sustained VA on WCD is linked to a ~7-fold higher 1-year VA recurrence post-MI.
Why the study?
Does the occurrence of sustained ventricular arrhythmia during the early post-infarction phase predict recurrent sustained VAs and 1-year mortality in patients with LVEF ≤ 35%?
Cohort (n=1,032)
Yes
Does the occurrence of sustained ventricular arrhythmia during the early post-infarction phase predict recurrent sustained VAs and 1-year mortality in patients with LVEF ≤ 35%?
Hazard Ratio: 6.91 (95% CI 3.73–12.81)
Absolute Event Rate: 22.2% vs 3.5%
p-value: p=<.0001
In patients with LVEF ≤ 35% post-MI, sustained ventricular arrhythmias during the early WCD phase strongly predict recurrent VAs and 1-year mortality after subsequent ICD implantation.
Background and Aims Prophylactic implantable cardioverter–defibrillators (ICDs) are not recommended until left ventricular ejection fraction (LVEF) has been reassessed 40 to 90 days after an acute myocardial infarction. In the current therapeutic era, the prognosis of sustained ventricular arrhythmias (VAs) occurring during this early post-infarction phase (i.e. within 3 months of hospital discharge) has not yet been specifically evaluated in post-myocardial infarction patients with impaired LVEF. Such was the aim of this retrospective study. Methods Data analysis was based on a nationwide registry of 1032 consecutive patients with LVEF ≤ 35% after acute myocardial infarction who were implanted with an ICD after being prescribed a wearable cardioverter–defibrillator (WCD) for a period of 3 months upon discharge from hospital after the index infarction. Results ICDs were implanted either because a sustained VA occurred while on WCD (VA+/WCD, n = 72) or because LVEF remained ≤35% at the end of the early post-infarction phase (VA−/WCD, n = 960). The median follow-up was 30.9 months. Sustained VAs occurred within 1 year after ICD implantation in 22.2% and 3.5% of VA+/WCD and VA−/WCD patients, respectively (P < .0001). The adjusted multivariable analysis showed that sustained VAs while on WCD independently predicted recurrence of sustained VAs at 1 year (adjusted hazard ratio [HR] 6.91; 95% confidence interval [CI] 3.73–12.81; P < .0001) and at the end of follow-up (adjusted HR 3.86; 95% CI 2.37–6.30; P < .0001) as well as 1-year mortality (adjusted HR 2.86; 95% CI 1.28–6.39; P = .012). Conclusions In patients with LVEF ≤ 35%, sustained VA during the early post-infarction phase is predictive of recurrent sustained VAs and 1-year mortality.
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Echivard et al. (2024) conducted a cohort in Early post-infarction left ventricular dysfunction (n=1,032). Sustained ventricular arrhythmia while on WCD vs. No sustained ventricular arrhythmia while on WCD was evaluated on Recurrence of sustained ventricular arrhythmias at 1 year (HR 6.91, 95% CI 3.73-12.81, p=<.0001). In patients with LVEF ≤35% post-MI, sustained ventricular arrhythmias during the early WCD phase strongly predicted 1-year VA recurrence (22.2% vs 3.5%; adjusted HR 6.91; 95% CI 3.73-12.81; P<.0001).
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