Follow-Up After Myocardial Infarction to Explore the Stability of Arrhythmogenic Substrate

Revascularization of coronary chronic total occlusions in an infarct‐related artery and recurrence of ventricular arrhythmias among patients with secondary prevention implantable cardioverter defibrillator

“…23 This generalized opinion is challenged by several reports demonstrating that the scar is a dynamic tissue, metabolically active, which undergoes a constant process of structural and electrical remodeling. 6,14,15 The results presented here are coherent with data from other reports showing a significant association between IRACTO and ventricular arrhythmias 1,3,4 and indicating a potential effect of IRACTO revascularization on the electrical remodeling of the scar 17,18 and the occurrence of VA or sudden death. [1][2][3][4] challenge this paradigm.…”

“…This remodeling may modulate the electrical properties of the scar 14 and favor the occurrence of VA: in fact, most VTs occur several years after the MI 3 . Recently, patients with a first MI treated with primary percutaneous coronary intervention were examined with serial cardiac magnetic resonance scans up to 4 years after the MI: a progressive reduction in the scar size, together with an increase in scar heterogenicity, were observed, confirming that scar remodeling persists during years 15 . However, no data exist about the long term remodeling of post‐MI scars associated with IRACTOs.…”

“…3 Recently, patients with a first MI treated with primary percutaneous coronary intervention were examined with serial cardiac magnetic resonance scans up to 4 years after the MI: a progressive reduction in the scar size, together with an increase in scar heterogenicity, were observed, confirming that scar remodeling persists during years. 15 17,18 Interestingly, a significant change in the electrical properties of the scar was already observed immediately after IRACTO revascularization and it further increased after 6 months. 17 Of note, the positive effect of IRACTO revascularization was mainly concentrated in the border zone which usually harbors the critical VT isthmus.…”

The boundaries between primary and secondary prevention with defibrillators after acute myocardial infarction: Gray areas of the terminology and definition

“…Indeed, little is known about the time course needed for completion of the scar healing process after an acute MI. 15,16 Although the purpose of the present study was to evaluate the benefit and risk of ICD therapy in patients with a prior MI presenting with VA in the setting of acute cardiac ischemia, the groups seem not homogeneous. Inclusion of both sustained MVT (as a substrate marker) and VF (primary or secondary as degenerated from MVT) in patients with acute coronary syndrome into group A would make difficult for appropriate clarification and decision making.…”

Bear track hypothesis in outcomes of ventricular tachycardia ablation: Risk factor or risk marker or both for heart failure?

“…On the other side, it is clear and mandatory to intervene aggressively when an electrical storm occurs, although there is still a lack of clarity about triggering mechanism and role of electrical storm in accelerating mortality 11 . Therefore, the correct timing and selection of patients determine the success of VT ablation as a curative or palliative approach and a shift in our goal of VT ablation 2,10,12 . We should be able to define the optimal time when it is not too early or late to perform the ablation procedure.…”