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Prognostic value of ventricular arrhythmia in early post-infarction left ventricular dysfunction: the French
Mathieu Echivard1, Jean-Marc Sellal1,2, Chloé Ziliox1
1Department of Cardiology, CHRU-Nancy, Université de Lorraine, Nancy, 1 rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France.
Insights
Sustained ventricular arrhythmias (VAs) during the early post-myocardial infarction phase in patients with reduced ejection fraction predict future arrhythmias and mortality. Early VA events are critical indicators for risk stratification and management decisions.
Area of Science:
- Cardiology
- Electrophysiology
- Critical Care Medicine
Background:
- Prophylactic implantable cardioverter-defibrillators (ICDs) are typically recommended after reassessment of left ventricular ejection fraction (LVEF) 40-90 days post-myocardial infarction (MI).
- The prognosis of sustained ventricular arrhythmias (VAs) within 3 months of hospital discharge in post-MI patients with impaired LVEF remains understudied in the current therapeutic landscape.
Purpose of the Study:
- To evaluate the prognostic significance of early sustained ventricular arrhythmias (VAs) in patients with impaired LVEF post-acute myocardial infarction.
- To assess the association between early VAs and subsequent VA recurrence and mortality.
Main Methods:
- Retrospective analysis of a nationwide registry including 1032 patients with LVEF ≤ 35% post-MI.
- Patients received a wearable cardioverter-defibrillator (WCD) for 3 months post-discharge, with ICD implantation based on early VA occurrence or persistent LVEF ≤ 35%.
Main Results:
- Sustained VAs occurred in 22.2% of patients who experienced VAs during WCD therapy versus 3.5% in those without (P < .0001).
- Early sustained VAs while on WCD independently predicted VA recurrence at 1 year (aHR 6.91) and end of follow-up (aHR 3.86).
- Early VAs also predicted 1-year mortality (aHR 2.86).
Conclusions:
- In post-MI patients with LVEF ≤ 35%, the occurrence of sustained VA during the early post-infarction phase is a significant predictor of future VA recurrence.
- Early sustained VA is also a strong predictor of increased 1-year mortality in this high-risk population.
Background And Aims:
Prophylactic implantable cardioverter-defibrillators (ICDs) are not recommended until left ventricular ejection fraction (LVEF) has been reassessed 40 to 90 days after an acute myocardial infarction. In the current therapeutic era, the prognosis of sustained ventricular arrhythmias (VAs) occurring during this early post-infarction phase (i.e. within 3 months of hospital discharge) has not yet been specifically evaluated in post-myocardial infarction patients with impaired LVEF. Such was the aim of this retrospective study.
Methods:
Data analysis was based on a nationwide registry of 1032 consecutive patients with LVEF ≤ 35% after acute myocardial infarction who were implanted with an ICD after being prescribed a wearable cardioverter-defibrillator (WCD) for a period of 3 months upon discharge from hospital after the index infarction.
Results:
ICDs were implanted either because a sustained VA occurred while on WCD (VA+/WCD, n = 72) or because LVEF remained ≤35% at the end of the early post-infarction phase (VA-/WCD, n = 960). The median follow-up was 30.9 months. Sustained VAs occurred within 1 year after ICD implantation in 22.2% and 3.5% of VA+/WCD and VA-/WCD patients, respectively (P < .0001). The adjusted multivariable analysis showed that sustained VAs while on WCD independently predicted recurrence of sustained VAs at 1 year (adjusted hazard ratio [HR] 6.91; 95% confidence interval [CI] 3.73-12.81; P < .0001) and at the end of follow-up (adjusted HR 3.86; 95% CI 2.37-6.30; P < .0001) as well as 1-year mortality (adjusted HR 2.86; 95% CI 1.28-6.39; P = .012).
Conclusions:
In patients with LVEF ≤ 35%, sustained VA during the early post-infarction phase is predictive of recurrent sustained VAs and 1-year mortality.
