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Therapeutic Addressal of Post-Myocardial Infarction Ventricular Tachycardia: Implantable Cardiac Defibrillator Versus Medical Therapy

Nikhila Pachani Assistant Professor, U.N. Mehta Institute of Cardiology & Research Centre, Ahmedabad, Gujarat 380016, India. , Nikhila Pachani* , Praveen G. Pai**

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Journal of Cardiovascular Medicine and Surgery 3(2):p 132-138, Jul-Dec 2017. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.3217.9

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Abstract

Objective: Sudden death due to the occurrence of sustained ventricular arrhythmia (VA) is the main contributor to total mortality in these highrisk postMyocardial infarction (MI) patients, accounting for about 40% of all deaths. We aimed to assess long term follow up of patients with prior MI and Left Ventricular dysfunction (LVD) undergoing automatic implantable cardioverterdefibrillator (AICD) insertion for primary and secondary prophylaxis. Methods: All patients who had prior MI and LVD with symptomatic Ventricular Tachycardia (VT) or patients who underwent electrophysiological studies for inducing VT during 2000 to August 2013 were included for the retrospective analysis. Age, gender, clinical features, addictions, LVEF, survival, recurrence of arrhythmia, recurrence of symptoms and hospitalization for congestive heart failure (CHF), device therapy, were considered for the analysis. Results: In our study we had age matched patients with male predominant patient population. We found that Holter study was less predictive than electrophysiological study in detecting VT in patients with MI and LVD. It was found to have 15% survival benefit in AICD group. There was increased hospitalization in AICD group compared to NonAICD group. Recurrence of arrhythmia and syncope was lower in AICD group whereas hospitalization due to CHF was higher in AICD patients. Conclusions: Our study shows that the implantation of a defibrillator in patients with a prior MI and LVD, with symptomatic or inducible VA on electrophysiological study has survival benefit, with increased incidence of hospitalization which can be attributed to Device therapy, CHF and morbidity due to longer life.

 

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.3217.9

Keywords

Post MI; Ventricular Tachycardia; LV Dysfunction; Syncope; AICD. 

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