Arrhythmic death and ICD implantation after myocardial infarction
Abstract
Overview
Arrhythmic death remains one of the most important causes of mortality after an
acute myocardial infarction also in the revascularization era. As a consequence, identification of
patients at risk should be performed before discharge. Unfortunately, in the clinical practice, this
evaluation is mainly based on detection of a depressed left ventricular ejection. This approach,
however, cannot adequately distinguish arrhythmic versus non-arrhythmic risk.
This issue is of critical relevance when considering that arrhythmic death can be significantly reduced
by appropriate interventions of implantable cardioverter defibrillator. Available evidence,
however, indicates that in the first month after myocardial infarction, device implantation does
not significantly reduce cardiac mortality: it seems that the reduction of arrhythmic death is
counterbalanced by an increase in rate of death from non arrhythmic cause. It is therefore to be
hoped that, in the future, arrhythmic risk evaluation will be based not only on the extent of left
ventricular dysfunction but also on the analysis of other risk markers such as those reflecting autonomic
dysfunction, cardiac electrical instability and presence of subclinical inflammation.
(Heart International 2006; 2: 12-6)
Keywords
Sudden cardiac death, Acute myocardial infarction, Implantable cardioverter defibrillator, T wave alternans
Article Information
Correspondence
Federico Lombardi, MD, FESC, Cardiologia, Dip. di Medicina, Chirurgia e Odontoiatria, Osp. San Paolo, University of Milan, Via A. di Rudinì, 8, 20142 Milano – Italy, Federico.Lombardi@unimi.it
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