Can Ambulatory Electrocardiographic (Holter) Testing Accurately Differentiate Patients at Higher Versus Lower Risk of Death After Myocardial Infraction?

Abstract

60 years) & baseline LVEFs (42% vs. 43%). Randomized subjects were more likely to have prominent heart failure symptoms (6% vs. 2%) & be female (22% vs. 11%). Of the 18 deaths in follow-up, 16 occurred in the Randomized group. The odds of death in Randomized subjects was 9.6 (95% confidence interval 2.8 to 32.5) fold higher vs. Registry subjects (p ¼ 0.0004). CONCLUSION: The presence of both abnormal cardiac depolarization & impaired autonomic tone in post-MI patients with better-preserved LV function identifies a group with a nearly 10-fold higher risk of death. The REFINE ICD study is testing whether ICD therapy can alter that risk.

Sudden cardiac death in patients with myocardial infarction: 1.5 primary prevention

“…An ICD is designed to detect and treat life-threatening arrhythmias and then automatically discharge and defibrillate to significantly reduce malignant ventricular rhythms. Patients with an LVEF ≤35% after an MI are the main beneficiaries of ICD management and prevention [94]. However, the majority of patients who die suddenly after an MI have LVEFs >35% and are ineligible for ICD treatment ac-cording to current guidelines [95].…”