Relationship Between Nonsustained Ventricular Tachycardia After Non–ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death

Scirica, Benjamin M.; Braunwald, Eugene; Belardinelli, Luiz; Hedgepeth, Chester M.; Špinar, Jindřich; Wang, Whedy; Qin, Jie; Karwatowska‐Prokopczuk, Ewa; Verheugt, Freek W.A.; Morrow, David A.

doi:10.1161/circulationaha.110.937136

Cited by 114 publications

(32 citation statements)

References 38 publications

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“…No randomized trials Observational study: nonpredictive of arrhythmic death 48 No randomized trials Observational studies: predictive 57,58 and nonpredictive 59 of arrhythmic death Nonsustained VT Randomized ICD trials: no survival benefit (combined with LVEF) 17 Observational study: predictive of arrhythmic death 60 Randomized ICD trials: survival benefit (combined with LVEF and a positive EPS) 15 …”

Section: Qrs Durationmentioning

confidence: 99%

Sudden Cardiac Death Early After Myocardial Infarction

2014

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The issue of SCD primary prevention early after MI remains unresolved. The focus is now firmly centered on the elucidation of risk stratification tests that effectively select patients at high risk of SCD who benefit from early ICD implantation. Zaman and Kovoor Primary Prevention of SCD Early After MI 2429A summary of major risk stratification tests currently used to identify patients at high risk of SCD is given in Table 2. LV DysfunctionImpaired LVEF, one of the most powerful predictors of survival, 64 has been shown to identify patients who derive a mortality benefit from an ICD when implanted predominantly in the remote period after MI. 16,65 However, there are major concerns with the use of LVEF alone as a risk stratifier to guide ICD implantation. One such concern is the low specificity of LVEF for selecting patients who experience arrhythmic versus nonarrhythmic death. In the MADIT II trial, the use of LVEF ≤30% alone to stratify patients for an ICD resulted in relatively small absolute improvement in mortality with low therapeutic efficiency (15-17 defibrillators per life saved). 66 Another concern is the sensitivity of LVEF, given that a large proportion of SCDs still occur in patients with preserved LV function. VALIANT demonstrated that, although the risk of SCD is greatest in patients with severe dysfunction (LVEF ≤30%), almost half of all sudden deaths occur in patients with a higher ejection fraction (LVEF, 31%-40%). 5 The use of LVEF as a risk stratification tool has been tested in the early post-MI stage in the DINAMIT and IRIS trials, which selected patients with LVEF ≤35% and ≤40%, respectively, and failed to show a benefit of early ICD implantation. 12,17 The major limitation with the use of an early LVEF cutoff is the phenomenon of myocardial stunning with variable and unpredictable recovery of LV function after MI. This is especially relevant in the contemporary era of primary PCI for STEMI. Of STEMI patients with LVEF ≤40% at day 3, 24% will improve to have an LVEF >40% at 6 months with a mean 6% relative improvement. 67 Hence, although LV function will invariably be incorporated into risk stratification models for the prevention of SCD, it is clear that other tests are required to adequately select high-risk patients early after MI. RV DysfunctionAlthough impaired LV function has been studied extensively as a predictor of mortality and arrhythmic death, RV dysfunction has been largely overlooked. We know from the VALIANT study that almost 50% of arrhythmic deaths occur in patients with a preserved LVEF.5 RV involvement in inferior MI has been shown to be a predictor of morbidity and mortality, with a higher rate of serious arrhythmias in patients with inferior MI and RV dysfunction. 68,69 In addition, RV dysfunction has been correlated with increased inducibility of VT at EPS. 70 Although there is no current evidence to support the role of early RV assessment to guide ICD implantation, these findings highlight the inadequacy of LVEF alone as a risk stratification tool for the prevention...

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Section: Qrs Durationmentioning

confidence: 99%

Sudden Cardiac Death Early After Myocardial Infarction

2014

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“…According to MERLIN‐TIMI 36 trial,10 ranolazine suppresses ventricular arrhythmias during the first week after admission for non‐ST elevation acute coronary syndrome, which can decrease the incidence of sudden cardiac death 22. Additionally, the RAID trial showed that ranolazine can significantly decrease VT episodes requiring antitachycardia pacing (ATP) compared to placebo patients while did not show a significant difference in the combined endpoint VT/VF or death.…”

Section: Resultsmentioning

confidence: 99%

Impact of ranolazine on ventricular arrhythmias – A systematic review

Bazoukis

Tse

Letsas

et al. 2018

Journal of Arrhythmia

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Ranolazine is a new medication for the treatment of refractory angina. However, except its anti‐anginal properties, it has been found to act as an anti‐arrhythmic. The aim of our systematic review is to present the existing data about the impact of ranolazine in ventricular arrhythmias. We searched MEDLINE and Cochrane databases as well clinicaltrials.gov until September 1, 2017 to find all studies (clinical trials, observational studies, case reports/series) reported data about the impact of ranolazine in ventricular arrhythmias. Our search revealed 14 studies (3 clinical trials, 2 observational studies, 8 case reports, 1 case series). These data reported a beneficial impact of ranolazine in ventricular tachycardia/fibrillation, premature ventricular beats, and ICD interventions in different clinical settings. The existing data highlight the anti‐arrhythmic properties of ranolazine in ventricular arrhythmias.

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“…According to MERLIN‐TIMI 36 trial, ranolazine suppresses VA during the first week after admission for non‐ST elevation acute coronary syndrome 14. In such patients, even short VT episodes of only few beats are associated with the risk of sudden cardiac death 19.…”

Section: Discussionmentioning

confidence: 99%

Ranolazine: safe and effective in a patient with hypertensive cardiomyopathy and multiple episodes of electrical storm

Margos

Mokadem

et al. 2017

Clinical Case Reports

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Key Clinical MessageAmong implantable cardioverter‐defibrillator (ICD) recipients, there are patients with recurrent episodes of electrical storm (ES), retractable to the optimal antiarrhythmic drug therapy or invasive ablation procedures. A relatively novel anti‐ischemic drug with also antiarrhythmic properties, ranolazine, may effectively suppress ventricular arrhythmias in such patients for a long period of time.

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Relationship Between Nonsustained Ventricular Tachycardia After Non–ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death

Cited by 114 publications

References 38 publications

Sudden Cardiac Death Early After Myocardial Infarction

Sudden Cardiac Death Early After Myocardial Infarction

Impact of ranolazine on ventricular arrhythmias – A systematic review

Ranolazine: safe and effective in a patient with hypertensive cardiomyopathy and multiple episodes of electrical storm

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