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QUARTERLY FOCUS ISSUE: HEART RHYTHM DISORDERS: VIEWPOINT

Implantable Cardioverter-Defibrillator Therapy After Acute Myocardial Infarction

The Results Are Not Shocking

Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Manuscript received April 13, 2009; revised manuscript received July 16, 2009, accepted August 10, 2009.

^_* Reprint requests and correspondence: Dr. Jeffrey J. Goldberger, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg 8-503, Chicago, Illinois 60611 (Email: j-goldberger{at}northwestern.edu).

The risk of sudden death is highest early after myocardial infarction (MI) and progressively declines over the ensuing 6 to 12 months. Nevertheless, several randomized clinical trials have failed to show a survival benefit for implantable cardioverter-defibrillators when implanted early after MI in high-risk patients. The etiology of this acute MI–sudden cardiac death paradox is unclear, but may be related to the changing nature of the substrate over the several month period after acute MI. Further investigation is needed to delineate the actual causes of death in the early post-MI period and which interventions can be implemented to reduce the increased rate of sudden death that is observed.

Key Words: myocardial infarction • sudden death • implantable defibrillator

Abbreviations and Acronyms   ICD = implantable cardioverter-defibrillator   MI = myocardial infarction

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