Evolution of left ventricular ejection fraction after acute myocardial infarction: implications for implantable cardioverter-defibrillator eligibility.
نویسندگان
چکیده
BACKGROUND Implantable cardioverter-defibrillator therapy improves survival in patients with reduced left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). Although the risk of sudden cardiac death is highest in the first month after AMI, there is no survival benefit of early implantable cardioverter-defibrillator implantation, and the optimal time frame has yet to be established. Thus, the aim of this study was to investigate what proportion of post-AMI patients had improved LV function to such an extent that the indication for implantable cardioverter-defibrillator was no longer present. METHODS AND RESULTS Patients admitted for AMI with reduced LVEF (≤40%) were eligible for inclusion. Repeat echocardiographic examinations were performed 5 days, 1 month, and 3 months after the AMI. We prospectively included 100 patients with LVEF of 31±5.8% after AMI. At the 1-month follow-up, 55% had an LVEF >35%. The main improvement in LVEF had occurred by 1 month. The mean difference in LVEF over the next 2 months was small, 1.9 percentage units. During the first 9 weeks, 10% of the patients suffered from life-threatening arrhythmias. CONCLUSIONS Most patients have improved LVEF after AMI, and in the majority, the improvement can be confirmed after 1 month, implying that further delay of implantable cardioverter-defibrillator implantation may not be warranted. Life-threatening arrhythmias occurred in 10% of the patients, illustrating the high risk for sudden cardiac death in this population.
منابع مشابه
Evolution of Left Ventricular Ejection Fraction After Acute Myocardial Infarction: Implications for Implantable Defibrillator Eligibility
Background—ICD therapy improves survival in patients with reduced left ventricular ejection
متن کاملEvolution of Left Ventricular Ejection Fraction After Acute Myocardial Infarction: Implications for Implantable Defibrillator Eligibility Running title: Sjöblom et al.; ICD early after myocardial infarction
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Strain echocardiography improves risk prediction of ventricular arrhythmias after myocardial infarction.
OBJECTIVES The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI). BACKGROUND Prediction of ventricular arrhythmias after MI is challenging. Left ventricular ejection fraction (LVEF) <35% is the main parameter for selecting patients for implantable cardioverter-defibrillator therap...
متن کاملResponse to letters regarding article, "long-term arrhythmia-free survival in patients with severe left ventricular dysfunction and no inducible ventricular tachycardia after myocardial infarction".
BACKGROUND A negative electrophysiology study (EPS) may delineate a subgroup of patients with severely impaired left ventricular ejection fraction (LVEF) whose care can be safely managed long-term without an implantable cardioverter-defibrillator. METHODS AND RESULTS Consecutive patients treated with primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction und...
متن کاملChanging late prognosis of acute myocardial infarction: impact on management of ventricular arrhythmias in the era of reperfusion and the implantable cardioverter-defibrillator.
Sudden cardiac death (SCD) causes approximately 3 million fatalities in the United States annually.1 With the advent of the implantable cardioverter-defibrillator (ICD), an intervention that reduces the risk of arrhythmogenic death is available.2–4 The challenge is to identify risk factors for SCD among most patients at relatively low risk, specifically including survivors of acute myocardial i...
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ورودعنوان ژورنال:
- Circulation
دوره 130 9 شماره
صفحات -
تاریخ انتشار 2014