Don't Rush to Implant ICDs After MI in High-Risk Patients

Implantable cardioverter-defibrillators (ICDs) prolong survival when used as prophylaxis in patients with ischemic or nonischemic cardiomyopathy and severe left-ventricular dysfunction. Although ICDs have shown benefits in patients with prior MI and severe LV dysfunction (Journal Watch Cardiology May 3 2002), the benefits after a very recent MI are unclear.

In an international, open-label, randomized trial of standard post-MI therapy versus single-chamber ICD therapy, researchers enrolled 674 patients (age range, 18-80; mean, 62) within 6 to 40 days after the event. All subjects had LV ejection fractions ≤35% and impaired cardiac autonomic function (depressed heart-rate variability) and, therefore, were at high risk for sudden death. Among t…