The post–myocardial infarction (MI) patient with left ventricular dysfunction (LVD)
is at risk for ventricular arrhythmias resulting in sudden cardiac death. In high-risk
post-MI patients with a depressed left ventricular ejection fraction, prophylactic
implantable cardioverter defibrillators (ICDs) may significantly improve survival.
These benefits are in addition to those of optimal pharmacologic therapy, and ICD
therapy should be considered the standard of care in these patients. Recent device
trials have demonstrated the benefits of prophylactic ICD placement in patients who
have been selected based on post-MI left ventricular systolic dysfunction alone. In
addition, cardiac resynchronization therapy can improve the quality of life beyond
that achievable with drug therapy alone and should be considered in patients with
symptomatic heart failure with QRS prolongation. Further risk stratification studies
of post-MI LVD patients will allow ICD therapy to be applied in a more cost-effective
manner.
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