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Raviele, Antonio; Bongiorni, Maria Grazia; Brignole, Michele; Cappato, Riccardo; Capucci, Alessandro; Gaïta, Fiorenzo; Gulizia, Michele Massimo; Mangiameli, S; Montenero, A. S.; Pedretti, Roberto F.E.; Uriarte, Jorge Antonio Salerno; Sermasi, S.; Nisam, Seah; Investigators, Best + Icd Trial

doi:10.1016/j.eupc.2005.03.003

Cited by 45 publications

(7 citation statements)

References 23 publications

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“…Nine studies, enrolling 3959 patients, were included in the systematic review and meta-analyses. Of these, two were randomized trials (MUSTT (Multicenter Unsustained Tachycardia Trial) [ 13 ] and BEST + ICD (BEta-blocker STrategy plus ICD) [ 23 ]), one was a post-hoc analysis of a previous randomized trial (MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II)) [ 18 ], and six were prospective non-randomized trials [ 7 , [24] , [25] , [26] , [27] , [28] ]. The study by Zaman et al [ 28 ] was included despite a partial overlapping (~40%) with that by Kumar et al [ 27 ], given the application of different patients' selection criteria.…”

Section: Resultsmentioning

confidence: 99%

“…In four studies [ 23 , 24 , 27 , 28 ] EPS was performed early after MI (within a month), and ventricular arrhythmias-inducibility showed a high predictive power for the subsequent arrhythmic events (OR = 7.85). These data open an important clinical scenario.…”

Section: Discussionmentioning

confidence: 99%

“…Probably, only the combination of different markers in a poly-parametric evaluation framework may allow a significant improvement in the stratification of the arrhythmic risk [ 36 ]. In four studies of the present meta-analysis [ 7 , 13 , 23 , 24 ], EPS was performed in patients pre-selected by non-invasive methods ( Table 1 ). However, differences in study protocols and pre-selection tests hindered the evaluation of the potential prognostic improvement provided by a poly-parametric evaluation including EPS.…”

Section: Discussionmentioning

confidence: 99%

“…Except for two randomized trials [ 13 , 23 ], all the studies included in the meta-analysis were prospective observational or post-hoc analysis studies more open to the risk of bias. Specific tests were performed to evaluate the presence of heterogeneity and publication bias in the overall set of studies, which pointed out the presence of both features.…”

Section: Limitationsmentioning

confidence: 99%

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Ventricular tachycardia-inducibility predicts arrhythmic events in post-myocardial infarction patients with low ejection fraction. A systematic review and meta-analysis

Disertori

Masè

Rigoni³

et al. 2018

IJC Heart & Vasculature

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BackgroundInducibility of ventricular arrhythmias at electrophysiological study (EPS) has long been suggested as predictive for subsequent arrhythmic events. Nevertheless, the usefulness of EPS in the clinical practice is still unclear. We performed a systematic review and meta-analysis to assess the predictive power of EPS in primary prevention of ventricular arrhythmias in post-myocardial infarction (MI) patients with left ventricular dysfunction.MethodsMEDLINE and the Cochrane Library databases were systematically searched to identify studies, which analyzed EPS predictive value in post-MI patients with mean EF < 40% for the composite arrhythmic endpoint defined by: sudden cardiac death (SCD), aborted SCD, ventricular tachycardia (VT), ventricular fibrillation (VF), appropriate implantable cardioverter-defibrillator (ICD) interventions.ResultsNine studies, evaluating 3959 patients with 647 arrhythmic events, were included in the meta-analyses. EPS showed a strong predictive power for the arrhythmic endpoint with a pooled odds ratio (OR) of 4.00 (95% confidence interval [CI]: 2.30–6.96) in the whole set of studies, albeit a high level of heterogeneity among studies. EPS predictive power was higher in studies where VT-inducibility was tested (OR 6.52; 95% CI: 2.30–18.44; sensitivity 0.65, specificity 0.78, and negative predictive value 0.94), versus those assessing VT/VF-inducibility (OR 2.09; 95% CI: 1.34–3.26). VT-inducibility was predictive even when assessed within one month after MI (OR 7.85; 95% CI: 3.67–16.80).ConclusionsInducibility of ventricular arrhythmias at EPS is a strong predictor of the arrhythmic endpoint in post-MI patients with impaired EF, particularly when VT-inducibility is tested. EPS could help selecting the patients who can mostly benefit from ICD therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Ventricular tachycardia-inducibility predicts arrhythmic events in post-myocardial infarction patients with low ejection fraction. A systematic review and meta-analysis

Disertori

Masè

Rigoni³

et al. 2018

IJC Heart & Vasculature

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show abstract

“…47 Although ICDs may reduce sudden death if implanted within the first few weeks after an MI, they appear to accelerate death from other causes, possibly heart failure, and have no overall effect on mortality. [48][49][50] On the other hand, the MADIT-II trial 43 suggests that late implantation of an ICD months or years after an MI in patients with an LVEF <30% is moderately effective at reducing all-cause mortality.…”

Section: Implantable Defibrillatorsmentioning

confidence: 99%

Applying evidence-based device care in cardiovascular patients: which patient with heart failure and what device?

Cleland¹,

Buga²,

Ghosh³

et al. 2010

JRCPE

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In terms of engineering, clinical understanding and application, device therapy remains in its infancy. In clinical trials, implantable cardiac defibrillators (ICDs) have greatly reduced the rate of sudden death and had a modest impact on mortality in a relatively broad range of patients. They do not generally improve symptoms and may make them worse. Cardiac resynchronisation therapy (CRT) devices have been used more selectively - probably far too selectively - and have shown substantial improvement in symptoms and a large reduction in mortality both by reducing sudden death and death due to heart failure. These effects are not explained solely by improved ventricular function, and the clinical response to therapy has so far not been predicted well by any method of assessing cardiac function or dyssynchrony. Reduction in brady-arrhythmia-triggered sudden death may be an underestimated benefit of biventricular pacing. In recent trials, heart failure patients implanted with a device have had a remarkably low mortality. This forces the clinical community to contemplate universal device use for patients with heart failure, except in those who have irremediable, life-limiting, non-cardiac disease. For most patients this should be CRT or a combination of CRT and an ICD (CRT-D).

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European Heart Rhythm Association/Heart Failure Association joint consensus document on arrhythmias in heart failure, endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society

Lip¹,

Heinzel²,

Gaïta³

et al. 2015

European J of Heart Fail

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Abstract: Despite optimal therapy, mortality remains significant in high-risk patients following MI. Although there is a trend in favour of EPS-guided/ICD, our data are insufficient to demonstrate a survival benefit of this strategy early after MI.

Cited by 45 publications

References 23 publications

Ventricular tachycardia-inducibility predicts arrhythmic events in post-myocardial infarction patients with low ejection fraction. A systematic review and meta-analysis

Ventricular tachycardia-inducibility predicts arrhythmic events in post-myocardial infarction patients with low ejection fraction. A systematic review and meta-analysis

Applying evidence-based device care in cardiovascular patients: which patient with heart failure and what device?

European Heart Rhythm Association/Heart Failure Association joint consensus document on arrhythmias in heart failure, endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society

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