PMID- 16450813
OWN - NLM
STAT- MEDLINE
DCOM- 20060418
LR  - 20190829
IS  - 0160-9289 (Print)
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Linking)
VI  - 28
IP  - 11 Suppl 1
DP  - 2005 Nov
TI  - Post myocardial infarction, left ventricular dysfunction, and the expanding role 
      of cardiac implantable electrical devices.
PG  - I51-7
AB  - In patients post myocardial infarction (MI) at risk for fatal ventricular 
      arrhythmias, cardiac implantable devices offer a means of preventive therapy that 
      complements optimal pharmacologic therapy. In patients with depressed ejection 
      fractions, prophylactic implantable cardioverter defibrillators (ICDs) 
      significantly improve survival. The efficacy of ICDs in the primary prevention of 
      sudden cardiac death in patients post MI has been examined in a number of major 
      primary prevention trials. These trials demonstrated as much benefit as some 
      secondary prevention trials, which were conducted in high-risk patients who 
      already had a spontaneous sustained ventricular tachyarrhythmia. In patients who 
      are candidates for an ICD, best medical therapy for left ventricular dysfunction 
      should be in place for some time before implanting. This waiting period could 
      mean avoiding the implantation of a device in a patient who would heal 
      sufficiently with pharmacologic therapy alone. In New York Heart Association 
      (NYHA) class III and IV, patients with heart failure, and QRS intervals > or = 
      120 ms, cardiac resynchronization therapy (CRT) in combination with a 
      defibrillator is a valuable addition to optimal pharmacologic therapy. Recent 
      studies have demonstrated improved survival with CRT as well as improved quality 
      of life. The high cost of cardiac implantable devices has led the Centers for 
      Medicare and Medicaid Services to impose strict indications for use. However, it 
      is likely that indications will be broadened for ICDs to include selected 
      patients with left ventricular ejection fraction up to 40%, compared with the 
      current indication of < or = 30%. Implanted devices must be followed up 
      appropriately, with periodic interrogation and program adjustment to reduce the 
      risk for pacing-induced desynchronization and to optimize hemodynamic benefit.
FAU - Naccarelli, Gerald V
AU  - Naccarelli GV
AD  - Division of Cardiology, Pennsylvania State University, College of Medicine, The 
      Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA. 
      gnaccarelli@psu.edu
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
SB  - IM
MH  - Arrhythmias, Cardiac/etiology/physiopathology/therapy
MH  - Cardiac Pacing, Artificial
MH  - Clinical Trials as Topic
MH  - Cost-Benefit Analysis
MH  - *Defibrillators, Implantable/economics/standards
MH  - Humans
MH  - Medicaid
MH  - Medicare
MH  - Myocardial Infarction/complications/physiopathology/*therapy
MH  - Pacemaker, Artificial
MH  - Ventricular Dysfunction, Left/etiology/physiopathology/*therapy
PMC - PMC6653874
EDAT- 2006/02/03 09:00
MHDA- 2006/04/19 09:00
PMCR- 2009/08/18
CRDT- 2006/02/03 09:00
PHST- 2006/02/03 09:00 [pubmed]
PHST- 2006/04/19 09:00 [medline]
PHST- 2006/02/03 09:00 [entrez]
PHST- 2009/08/18 00:00 [pmc-release]
AID - CLC4960281309 [pii]
AID - 10.1002/clc.4960281309 [doi]
PST - ppublish
SO  - Clin Cardiol. 2005 Nov;28(11 Suppl 1):I51-7. doi: 10.1002/clc.4960281309.