Initial inclusion criteria (eligibility for Holter screening)

•    18 - 80 years old at time of consent

•    History of MI ≥ 2 months prior to screening based on ESC/ACCF/AHA/WHF criteria
     (both STEMI and NSTEMI subjects are eligible)

•    Appropriate post-MI management including revascularization where indicated

•    No contra-indication for transvenous ICD placement
     (e.g., mechanical tricuspid valve, known vascular access problems, active sepsis, etc.)
LVEF 36% - 50% measured at least 40 days after a confirmed MI ≥ 3 months after coronary angioplasty or coronary bypass
     surgery and within the following time windows:
                     - LVEF ≤  7 months of screening visit if index MI was  ≤ 1 year of enrolment
                     - LVEF ≤  13 months of screening visit if index MI was > 1 & < 3 years of enrolment
                     - LVEF ≤  25 months of screening visit if index MI was ≥ 3 years of enrolment

•    Proven, necessary or appropriate medications (e.g. beta-blocker, ACE inhibitor/ARB, statin, and anti-platelet)

•    In normal sinus rhythm (ECG documented) 8 weeks prior to the screening Holter

•    Written informed consent

•    Able and willing to complete the screening Holter, including the six-minute hall walk

Additional inclusion criterion (eligibility for randomization)

•    Abnormal HRT & TWA (core lab interpretation) on Holter performed at least 2 months after the index MI
     and the specified time after coronary revascularization

•    In normal sinus rhythm (ECG documented) within 8 weeks prior to the screening Holter

•    In normal sinus rhythm for ≥ 18 hours of the 24 hr screening Holter as determined by the study Holter Core Lab

Exclusion criteria (randomization or registry)

•    Use of antiarrhythmic drugs

•    Clinical indication for permanent pacemaker or a cardiac resynchronization device
•    Clinical indication for an ICD or cardiac resynchronization ICD

•    Prior implantation of a pacemaker, ICD, or Cardiac Resynchronization device

•    Any condition, in the investigator's judgment, that would limit life expectancy to < 12 months

•    Chronic renal failure (hemodialysis or peritoneal dialysis)

•    Active ischemia that is amenable to revascularization if not previously revascularized

•    Participation in another trial that may interfere with the REFINE ICD results

•    Pregnancy

•    Inability to comply with the follow-up schedule
REFINE ICD Clinical Coordinating Centre: TRW Building GE63, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada  |  Phone: 1-855-426-6328  |  Fax: (403) 210-8140  |  Contact Us
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