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Multicenter Study
. 2024 Nov 7;45(41):4428-4442.
doi: 10.1093/eurheartj/ehae575.

Prognostic value of ventricular arrhythmia in early post-infarction left ventricular dysfunction: the French nationwide WICD-MI study

Mathieu Echivard  1 , Jean-Marc Sellal  1   2 , Chloé Ziliox  1 , Eloi Marijon  3   4 , Pierre Bordachar  5   6 , Sylvain Ploux  5   6 , Karim Benali  5   6 , Christelle Marquié  7 , Clémence Docq  7 , Didier Klug  7 , Romain Eschalier  8 , Baptiste Maille  9 , Jean-Claude Deharo  9 , Dominique Babuty  10 , Thibaud Genet  10 , Estelle Gandjbakhch  11   12 , Antoine Da Costa  13 , Olivier Piot  14 , Damien Minois  15 , Jean-Baptiste Gourraud  15 , Pierre Mondoly  16 , Philippe Maury  16   17 , Serge Boveda  18 , Jean-Luc Pasquié  19 , Raphaël Martins  20 , Christophe Leclercq  20 , Charles Guenancia  21 , Gabriel Laurent  21 , Mathieu Becker  22 , Julien Bertrand  22 , Philippe Chevalier  23 , Vladimir Manenti  24   25 , Maciej Kubala  26 , Pascal Defaye  27 , Peggy Jacon  27 , Antoine Desbiolles  27 , Marc Badoz  28 , Laurence Jesel  29 , Nicolas Lellouche  30 , Paul-Ursmar Milliez  31 , Pierre Ollitrault  31 , Samir Fareh  32 , Matthieu Bercker  33 , Jacques Mansourati  34 , Benoît Guy-Moyat  35 , Jean-Pierre Chabert  36 , Nicolas Luconi  36 , Pierre-François Winum  37 , Frédéric Anselme  38 , Fabrice Extramiana  39 , Camille Delahaye  40 , François Jourda  41 , Olivier Bizeau  42 , Mathieu Nasarre  42 , Arnaud Olivier  43 , Stéphane Fromentin  44 , Thibault Villemin  45 , Olivier Levavasseur  46 , Néfissa Hammache  1 , Isabelle Magnin-Poull  1 , Hugues Blangy  1 , Nicolas Sadoul  1 , Kevin Duarte  47 , Nicolas Girerd  1   47 , Christian de Chillou  1   2
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Free article
Multicenter Study

Prognostic value of ventricular arrhythmia in early post-infarction left ventricular dysfunction: the French nationwide WICD-MI study

Mathieu Echivard et al. Eur Heart J. .
Free article

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Abstract

Background and aims: Prophylactic implantable cardioverter-defibrillators (ICDs) are not recommended until left ventricular ejection fraction (LVEF) has been reassessed 40 to 90 days after an acute myocardial infarction. In the current therapeutic era, the prognosis of sustained ventricular arrhythmias (VAs) occurring during this early post-infarction phase (i.e. within 3 months of hospital discharge) has not yet been specifically evaluated in post-myocardial infarction patients with impaired LVEF. Such was the aim of this retrospective study.

Methods: Data analysis was based on a nationwide registry of 1032 consecutive patients with LVEF ≤ 35% after acute myocardial infarction who were implanted with an ICD after being prescribed a wearable cardioverter-defibrillator (WCD) for a period of 3 months upon discharge from hospital after the index infarction.

Results: ICDs were implanted either because a sustained VA occurred while on WCD (VA+/WCD, n = 72) or because LVEF remained ≤35% at the end of the early post-infarction phase (VA-/WCD, n = 960). The median follow-up was 30.9 months. Sustained VAs occurred within 1 year after ICD implantation in 22.2% and 3.5% of VA+/WCD and VA-/WCD patients, respectively (P < .0001). The adjusted multivariable analysis showed that sustained VAs while on WCD independently predicted recurrence of sustained VAs at 1 year (adjusted hazard ratio [HR] 6.91; 95% confidence interval [CI] 3.73-12.81; P < .0001) and at the end of follow-up (adjusted HR 3.86; 95% CI 2.37-6.30; P < .0001) as well as 1-year mortality (adjusted HR 2.86; 95% CI 1.28-6.39; P = .012).

Conclusions: In patients with LVEF ≤ 35%, sustained VA during the early post-infarction phase is predictive of recurrent sustained VAs and 1-year mortality.

Keywords: Myocardial infarction; Risk stratification; Sudden cardiac death; Ventricular fibrillation; Ventricular tachycardia; Wearable cardioverter–defibrillator.

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