Identifying high risk patients post myocardial infarction with reduced left ventricular function using loop recorders...

Area of Science:

• Cardiology
• Electrophysiology
• Clinical Medicine

Background:

• Sudden cardiac death (SCD) remains a significant threat to myocardial infarction (MI) survivors, particularly in the months following the event.
• High mortality rates underscore the need for early risk stratification in post-MI patients.

Purpose of the Study:

• To determine the prevalence of significant arrhythmias in patients early after MI.
• To investigate the association between these arrhythmias and 12-month mortality.

Main Methods:

• The INSPIRE-ELR study enrolled 249 patients within 14 days post-MI with left ventricular ejection fraction (LVEF) ≤35%.
• Patients were monitored for 7 days using a wearable external loop recorder (ELR) starting approximately 5 days after MI.
• Data on arrhythmias and mortality at 12 months were analyzed.

Main Results:

• Of 233 patients completing monitoring, 81 (35%) had significant arrhythmias, including Ventricular Tachycardia/Fibrillation (VT/VF), frequent Premature Ventricular Contractions (PVCs), and Atrial Fibrillation (AF).
• Overall mortality was 10.7% (26 deaths).
• Patients with significant arrhythmias had a substantially higher 12-month mortality rate (23.6% vs. 4.8%, HR=5.5, p<0.0001).

Conclusions:

• Early application of external loop recorders (ELR) in acute myocardial infarction (MI) patients with left ventricular (LV) dysfunction identifies individuals at elevated risk of mortality.
• This monitoring strategy aids in risk stratification for improved patient management.