Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

Main Index

Table Of Contents

Question 32 of 39:

Before this patient is discharged a routine ambulatory (Holter) monitor recording is necessary to identify whether this patient will benefit from prophylactic anti-arrhythmic therapy.

You clicked 'True'

Incorrect!

Routine ambulatory (Holter) monitor recordings to identify patients who should receive anti-arrhythmic therapy at the time of discharge after an MI is therefore not presently indicated. There is little support at present for the hypothesis that suppression of premature ventricular complexes in post myocardial infarction will lower mortality. There are risks of traditional (class I) anti-arrhythmic therapy as observed in CAST, a study that tested suppressive anti-arrhythmic therapy targeted to patients with frequent and complex ectopy.

Amiodarone, a drug with class III (as well as Class I, II, and IV action) has shown promise in some but not all post-MI pilot studies. These potential benefits of empiric therapy with amiodarone after MI were tested recently in 2 moderate size-randomized trials involving post-MI patients at high risk due to LV dysfunction (European Myocardial Infarction Amiodarone Trial [EMIAT]) or ventricular arrhythmias (Canadian Amiodarone Myocardial Infarction Trial [CAMIAT]). In preliminary reports presented at the 1996 American College of Cardiology Session, amiodarone appeared to reduce arrhythmic death and cardiac arrest, but effects on total mortality was not significant. Also, tolerance of long-term amiodarone was poor (40% dropout rate). Therefore, amiodarone is safe to use after myocardial infarction, if necessary for suppression of severe, symptomatic arrhythmias but ß-adrenoceptor blocker therapy is preferred for general prophylaxis.