Arrhythmia Detection After Myocardial Infarction Trial
Samir Saba
Summary
Patients post acute myocardial infarction (AMI) have a high risk of mortality but the use of an implantable defibrillator in the early aftermath of an AMI has not been shown to improve patients' survival. The VEST trial recently demonstrated an improved overall survival in post AMI patients with the use of a wearable defibrillator. The same improvement was not demonstrated for the risk of sudden cardiac death. Monitoring patients after AMI using an implantable cardiac monitor (ICM) may document findings that can impact patient management and eventually improve their outcomes. We are therefore conducting the AID MI trial to examine the impact of ICM on patient management in the post AMI setting.
Description
Patients who have ventricular tachycardia or fibrillation at least 48 hours after an acute myocardial infarction (AMI) have a higher risk of sudden cardiac death. Current guidelines recommend that for primary prevention of sudden cardiac death, patients with left ventricular ejection fraction (LVEF) ≤ 35% should wait at least 40 days post-AMI or 90 days post revascularization prior to receiving an implantable cardioverter defibrillator (ICD). This period of time potentially leaves a vulnerable population without protection from sudden cardiac death (SCD). The landmark MADIT I and MADIT II tri…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Adults, age 18 years or older * AMI (STEMI and NSTEMI) * Willing to give written informed consent * Expected discharge from hospital within 7 days of AMI * Willing to receive ICM insertion within 21 days of index AMI Exclusion Criteria: * Existing pacemaker, ICD, ICM, or any other implantable cardiac electronic device * Pregnant * Index AMI was more than 21 days * Unwilling/cannot insert ICM within 21 days post AMI * Planned ICD implant, planned CABG or any open-heart surgery (e.g. for severe valvular disease)
Interventions
- OtherStandard of Care
Routine monitoring of post AMI patient with clinic visits
- DeviceICM Implantation
Implantation of ICM through small incision (2 mm) under the skin
Location
- UPMC Presbyterian HospitalPittsburgh, Pennsylvania