Response to Letter Regarding Article, “Pathogenesis of Sudden Unexpected Death in a Clinical Trial of Patients With Myocardial Infarction and Left Ventricular Dysfunction, Heart Failure, or Both”

Abstract

We thank Dr McEvoy for his interest in our article.1 Despite an increased risk of sudden death in the first weeks after myocardial infarction (MI), a retrospective analysis of Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II),2 the prospective randomized Defibrillator in Acute Myocardial Infarction (DINAMIT),3 and the Immediate Risk Stratification Improves Survival (IRIS)4 trials did not show a benefit of early implantable cardioverter-defibrillator (ICD) implantation after MI in patients with low ejection fraction. As pointed out by Dr McEvoy, the DINAMIT and IRIS trials also concluded that, although ICD therapy was associated with a reduction in the rate of arrhythmic death that was offset by an increase in the rate of nonarrhythmic death, high rates of cardiac mortality in the ICD group were from mechanisms other than tachyarrhythmia. Because the results of these trials were neutral, it is important to …