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Early Defibrillator After Heart Attack May Not Pay Off
Date:10/7/2009

uded more patients and have done a longer mean [average] follow-up," he said. "Our statistical power is based on [about] 230 deaths, while there were only 120 deaths in the other trial."

Also, the treatment of heart attacks has changed since the earlier trial was done, with artery-opening angioplasty much more common now, Steinbeck said. "In the other trial, 27 percent of patients underwent PCI [percutaneous coronary intervention, the medical term for angioplasty], while in our study it was much higher, more than 70 percent," he said.

The newly reported study results are not at all unexpected, said Dr. Arthur J. Moss, a professor of medicine and cardiology at the University of Rochester in New York and leader of a study reported in 2002 that led to guidelines against early installation of defibrillators after a heart attack.

"We thought they should not be implanted for at least three months, for a variety of reasons," Moss said. "We thought that putting one in early could contribute to heart failure, which is what this study found."

Indeed, analysis of Moss's earlier study had found that longer delays worked best, he said. "We looked at it by quartile, one to 18 months, 18 to 36 months," he said. "The only group that did not benefit got defibrillators in the first 18 months."

The new European study does not rule out later use of defibrillators for people who have had heart attacks, Steinbeck said. Defibrillators can save lives, he said, if implanted when someone develops a sustained abnormal heartbeat, such as ventricular fibrillation.

"If after 48 hours the arrhythmia is sustained, such a patient is a candidate for a defibrillator," Steinbeck said.

More information

The American Heart Association has more on implantable defibrillators.



SOURCES: Gerhard
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