Implantable cardioverter defibrillators after acute myocardial infarction

Despite major advances during the past two decades in the management of patients with acute myocardial infarction, sudden cardiac death remains an important contributor to overall mortality.1 Several randomised controlled trials have established the effectiveness of implantable cardioverter defibrillators in reducing overall mortality in patients with a history of myocardial infarction and reduced left ventricular ejection fraction.2 Although the risk of sudden cardiac death is greatest in the first 30 days after acute myocardial infarction, especially in patients with left ventricular dysfunction or heart failure,3 two trials found that the insertion of an implantable cardioverter defibrillator at this early stage did not reduce all cause mortality.4 5 A possible reason is an increase in non-arrhythmic death in the early post-infarct period. The findings of many of the early trials of implantable cardioverter defibrillators are reflected in current national and international guidelines, which recommend that these devices should be considered in patients with a previous myocardial infarction (after at least 40 days) and left ventricular ejection fraction below 30-35%⇓.6 7

A recent study has shed further …