Carlton MD, FACC, Timothy
Vice President Medical Staff Services
Hospital Corporation of America
The requirement for a 40 day wait for an ICD when a myocardial infarction has occurred should be waived in the event that the primary diagnosis on admission was a ventricular tachycardia or ventricular fibrillation out of hospital cardiac arrest WITHOUT a myocardial infarction and the myocardial infarction is ONLY a result of a subsequent percutaneous coronary intervention (PCI) done after admission. These patients usually have had only a small cardiac enzyme rise as the marker of a myocardial infarction and this should not cause a 40 day delay in treating the arrythmic event. This group of patients with a PCI induced M.I. by enzymes only was not represented in MADIT I or II or in DINIMIT. Patients that present with an M.I. and a lethal arrhythmia who are treated for ischemia could remain in this 40 day wait group as they do fit the DINIMIT criteria.