Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction:

Abstract

The ILR allowed the automatic detection of brady- and tachyarrhythmias in post-AMI patients, though a high incidence of false activations were observed. Clinically significant arrhythmias were recorded in a large number of patients with depressed left ventricular function early after AMI. This prompted the implantation of ICD or PM in nearly one third of patients.

American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death

“…Furthermore, it was recently shown that eplerenone reduced the risk of SCD by 37% at 30 days in a randomized trial of patients with acute MI, left ventricular systolic dysfunction, and heart failure, 203 which suggests that alternative therapies may be required during this time period to reduce the risk of SCD. The Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) study 204 is a multicenter study enrolling patients with an LVEF Յ40% after acute MI in whom a loop recorder is implanted to evaluate the incidence of tachyarrhythmia and bradyarrhythmia episodes. This study will specifically evaluate the value of 24-hour AECG, SAECG, QT dispersion, T-wave alternans, and electrophysiological testing as predictors of life-threatening arrhythmias in the early postinfarction period.…”

Long-Term Recording of Cardiac Arrhythmias With an Implantable Cardiac Monitor in Patients With Reduced Ejection Fraction After Acute Myocardial Infarction

“…The device was implanted subcutaneously with local anesthesia in the left parasternal area 5 to 21 days after the AMI and programmed as described earlier. 17 The programmed criteria for automatic arrhythmia storage correspond to the following situations: sinus bradycardia Յ30 bpm for Ն8 seconds, sinus arrest with pauses Ն5 seconds, and high-degree atrioventricular (AV) block (second-to third-degree AV block) Յ30 bpm lasting Ն8 seconds. Tachycardia was defined as a heart rate Ն125 bpm for Ն16 beats.…”

“…The reliability of these settings in arrhythmia detection was confirmed in a pilot study. 17 The limitations of implantable loop recorder device are described in detail in the Limitations section below. During follow-up, the memory of the loop recorder was interrogated first at 6 weeks after implantation and thereafter at 3-month intervals.…”

Implantable Loop Recorder Allows an Etiologic Diagnosis in One-Third of Patients

“…Since the first report of its implementation in 1998, 1 numerous studies have documented the role of ILR in the investigation of syncopal episodes, palpitations, 2 and atrial fibrillation, 3 as well as risk stratification after myocardial infarction. 4 The vast majority of these studies, however, were designed as clinical trials with rigid inclusion criteria and selected patients, LACUNZA-RUIZ FJ et al…”