Key result
Appropriate ICD therapy occurred in 45.6% of patients with ventricular arrhythmia in the setting of acute coronary syndrome, which was not significantly different from the 51.6% rate in patients without acute coronary syndrome.
Why the study?
It is unknown whether ICD implantation is beneficial in patients with prior MI and preserved LV function who develop sustained ventricular arrhythmias during an ACS, as the arrhythmia might be triggered by a reversible cause.
Does ICD implantation provide benefit (appropriate therapy) in patients with a history of MI presenting with VA in the setting of an ACS with preserved LVEF compared to established secondary prevention indications?
Observational (n=291)
Yes
Does ICD implantation provide benefit (appropriate therapy) in patients with a history of MI presenting with VA in the setting of an ACS with preserved LVEF compared to established secondary prevention indications?
Patients with a history of MI and preserved LVEF who experience ventricular arrhythmias during an ACS have high rates of appropriate ICD therapy, suggesting ICD implantation is warranted despite the reversible trigger.
Answers are grounded in this paper and cite their sources.
No immediate change to ICD management for ACS-related ventricular arrhythmia; leaves open need for prospective trials on arrhythmia substrate.
INTRODUCTION: In patients with a prior myocardial infarction (MI) but preserved left ventricular (LV) function, sustained ventricular arrhythmias (VAs) 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 analyze 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 left ventricular ejection fraction (LVEF) greater than 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 greater than 35% (group B) or ≤35% (group C). The primary endpoint was the number of patients with appropriate ICD therapy (antitachycardia pacing or shock). RESULTS: A total of 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 vs 51.6% and 60.4% in groups B and C (P = .11). In group A, 31.1% received an appropriate ICD shock vs 34.7% and 44.3% in control groups B and C (P = .12). CONCLUSION: On the basis of 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.
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Dijk et al. (2020) conducted an observational in Ventricular arrhythmia in the setting of acute cardiac ischemia and a history of myocardial infarction (n=291). Ventricular arrhythmia in the setting of acute coronary syndrome vs. Ventricular arrhythmia without acute coronary syndrome was evaluated on Appropriate ICD therapy (antitachycardia pacing or shock) (p=0.11). Appropriate ICD therapy occurred in 45.6% of patients with ventricular arrhythmia in the setting of acute coronary syndrome, which was not significantly different from the 51.6% rate in patients without acute coronary syndrome.
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