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CARISMA: Implantable cardiac monitor detected bradyarrhythmias, tachyarrhythmias in patients after acute MI
Thomsen P. Circulation. 2010;122:1258-1264.
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Clinically significant bradyarrhythmias and tachyarrhythmias were documented in patients with depressed left ventricular ejection fraction after acute MI with an implantable cardiac monitor, according to results from the CARISMA trial.
The Cardiac Arrhythmias and Risk Stratification after Myocardial Infarction (CARISMA) study included 5,869 patients who were screened in the acute phase of an acute MI, of which 1,393 patients had a LVEF of 40% or less. After exclusions, 297 patients (21%; mean age of 64 ± 11 years; LVEF of 31 ± 7%) received an implantable cardiac monitor (Reveal Plus 9526, Medtronic) within 11 ± 5 days of the acute MI and were followed up every 3 months for an average of 1.9 ± 0.5 years.
Researchers recorded bradyarrhythmias and tachyarrhythmias in 137 patients (46%), with 86% being asymptomatic. The implantable cardiac monitor detected a 28% incidence of new-onset atrial fibrillation with fast ventricular response (≥125 bpm).
Additional study data suggested that the monitor detected a 13% incidence of nonsustained ventricular tachycardia (≥16 beats); 10% incidence of high-degree atrioventricular block (≤30 bpm lasting ≥8 seconds); 7% incidence of sinus bradycardia (≤30 bpm lasting ≥8 seconds); 5% incidence of sinus arrest (≥5 seconds); 3% incidence of sustained ventricular tachycardia; and a 3% incidence of ventricular fibrillation.
“Clinically significant bradyarrhythmias and tachyarrhythmias were documented in a substantial proportion of patients, most of them asymptomatic. A large number of the documented arrhythmias would result in device therapy according to the current guidelines,” the researchers concluded. “However, the study was observational, and whether the use of implantable cardiac monitors in this population could improve clinical outcome should be tested in larger randomized trials.”
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