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Current guidelines do not recommend ICD therapy for secondary prevention of sudden death in patients who develop ventricular arrhythmia within 48h of MI (early VA). We aimed to determine characteristics and clinical outcomes of patients receiving ICD outside of guidelines.
This retrospective study included 128 consecutive subjects meeting ICD9 diagnosis codes of acute MI and early VA during the same hospitalization between 2002 and 2012. Subjects qualifying for ICD for primary prevention (baseline ejection fraction [EF] <35%) were excluded. The ICD database was cross-searched and appropriate ICD therapies were identified.
Twenty percent (26/128) of subjects with early VA received ICD. ICD recipients were more likely to have prior MI (46 vs 17%, p=0.001), PCI (35 vs 13%, p=0.008) or CABG (35 vs 7%, p<0.001), and were more likely to have preceding NSTEMI (65 vs 24%, p<0.001). Although pre-MI baseline EF were similar (56±13 vs 60±10%, p=0.33), post-MI EF (35±16 vs 45±15%, p=0.003) were lower in ICD recipients. During a mean follow-up of 3.1±2.7 years, 12/26 (46%) ICD recipients had appropriate ICD therapy. Kaplan-Meier survival estimate showed a lower survival rate in ICD recipients (Figure; p=0.026).
Patients receiving ICD for resuscitated VA within 48h of MI due to suspected nonreversible arrhythmogenic substrate have more adverse clinical characteristics at presentation. These subjects had high rates of appropriate ICD therapy and mortality during follow-up.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: Devices III – Use of Arrhythmia Devices in Novel Patient Populations
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1235M-28
- 2013 American College of Cardiology Foundation