Key result
Early arrhythmia detection via external loop recorders post-MI is linked to ~450% higher 12-month mortality.
Why the study?
Sudden cardiac death remains a devastating complication following myocardial infarction, with high mortality in the initial months.
Does the detection of significant arrhythmias using a wearable external loop recorder early after MI identify patients at high risk of mortality?
Cohort (n=249)
Yes
Does the detection of significant arrhythmias using a wearable external loop recorder early after MI identify patients at high risk of mortality?
Answers are grounded in this paper and cite their sources.
Early monitoring with a wearable external loop recorder in post-MI patients with severe LV dysfunction identifies a subgroup with significant arrhythmias who are at a substantially higher risk of 12-month mortality.
AIMS: Sudden cardiac death (SCD) continues to be a devastating complication amongst survivors of myocardial infarction (MI). Mortality is high in the initial months after MI. The aims of the INSPIRE-ELR study were to assess the proportion of patients with significant arrhythmias early after MI and the association with mortality during 12 months of follow-up. METHODS: The study included 249 patients within 14 days after MI with left ventricular ejection fraction (LVEF) ≤35% at discharge in 11 hospitals in India. Patients received a wearable external loop recorder (ELR) 5 ± 3 days after MI to monitor arrhythmias for 7 days. RESULTS: Patients were predominantly male (86%) with a mean age of 56 ± 12 years. In 82%, reperfusion had been done and all received standard of care cardiovascular medications at discharge. LVEF was 32.2 ± 3.9%, measured 5.1 ± 3.0 days after MI. Of the 233 patients who completed monitoring (7.1 ± 1.5 days), 81 (35%) experienced significant arrhythmias, including Ventricular Tachycardia/Fibrillation (VT/VF): 10 (4.3%); frequent Premature Ventricular Contractions (PVCs): 65 (28%); Atrial Fibrillation (AF): 8 (3.4%); chronic atrial flutter: 4 (1.7%); 2nd or 3rd degree Atrioventricular (AV) block: 4 (1.7%); and symptomatic bradycardia: 8 (3.4%). In total, 26 patients died. Mortality was higher in patients with clinically significant arrhythmia (at 12 months: 23.6% vs 4.8% with 19 vs 7 deaths, hazard ratio (HR) = 5.5, 95% confidence interval (CI) 2.3 to 13.0, p < 0.0001). Excluding 7 deaths during ELR monitoring, HR = 4.5, p < 0.001. CONCLUSION: ELR applied in patients with acute MI and LV dysfunction at the time of discharge identifies patients with high mortality risk.
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Singh et al. (2022) conducted a cohort in Myocardial infarction with reduced left ventricular function (n=249). Wearable external loop recorder (ELR) monitoring vs. Patients without clinically significant arrhythmia was evaluated on Mortality at 12 months (HR 5.5, 95% CI 2.3 to 13.0, p=< 0.0001). Early detection of clinically significant arrhythmias using a wearable external loop recorder post-MI was associated with significantly higher 12-month mortality (23.6% vs 4.8%; HR 5.5, 95% CI 2.3-13.0).
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