Cardiology ·
Arrhythmia and Heart Failure Events Are Linked After MI in ICD Recipients
In a multicentre analysis of 1,014 patients with persistent left ventricular dysfunction after myocardial infarction, ventricular arrhythmias and heart failure events were associated in both directions. Both were also associated with higher all-cause mortality during a median 2.6 years of follow-up after ICD implantation.
- VA and HF events were associated in both directions.
- Both events were independently associated with all-cause mortality.
- Findings apply to selected post-MI patients with persistent LV dysfunction.
- Observational associations do not establish causality.
Researchers analysed 1,014 participants in the multicentre WICD-MI study. All had received a wearable cardioverter-defibrillator after acute myocardial infarction and later underwent implantable cardioverter-defibrillator (ICD) implantation, with left ventricular ejection fraction remaining at or below 35%. Time-dependent Cox models assessed associations between ICD-treated ventricular arrhythmias (VA), heart failure (HF) events—hospitalization, transplantation or left ventricular assist device implantation—and all-cause mortality. Median follow-up after ICD implantation was 2.6 years.
VA was associated with subsequent HF events (adjusted hazard ratio [aHR] 3.50, 95% CI 1.66–7.38), and HF events were associated with subsequent VA (aHR 2.96, 95% CI 1.59–5.50). Both were independently associated with mortality: aHR 4.43 (2.35–8.36) for VA and 7.96 (4.71–13.47) for HF events. The association between VA and HF was strongest for shock-treated arrhythmias. Exploratory analyses found a stronger association in subcutaneous ICD recipients than in transvenous ICD recipients, but the subgroup estimate was imprecise.
These observational findings identify co-occurring risks in a selected post-MI population with persistent LV dysfunction; they do not establish causality or show that a particular management strategy improves outcomes.
In practice
For patients with persistent LV dysfunction after MI who receive an ICD, this study found that ICD-treated ventricular arrhythmias and major HF events were each associated with later occurrence of the other and with mortality. The findings support recognizing arrhythmia and HF events as interrelated risks in this population, but they do not show that intensified or altered integrated management improves outcomes. The analysis was observational, and the subgroup result by ICD type was exploratory and imprecise; it should not alone determine device selection or treatment.
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European Journal of Heart Failure: Ventricular arrhythmia–heart failure interaction and mortality in ICD recipients after myocardial infarction ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.