BACKGROUND:Optimisation of medical therapy is recommended for patients with newly diagnosed non-ischaemic cardiomyopathies (NICM) before consideration of a primary preventive implantable cardioverter-defibrillator (ICD). During this optimisation period, patients face a potentially elevated risk for sudden cardiac death (SCD) that can be countered with a wearable cardioverter-defibrillator (WCD). This systematic review aims to assess the risk for SCD in patients with newly diagnosed NICM. METHODS:A systematic review was performed in Medline, Embase and Cochrane Library last updated on March 2025. Studies with patients aged ≥18 years with newly diagnosed NICM (≤90 days) who were recipients of WCD were included. Study selection, study quality assessment and data extraction were performed by two reviewers independently. Data on percentage of patients with appropriate WCD shocks (as proxy for sustained ventricular arrhythmia, potentially leading to SCD), inappropriate WCD shocks and device implantation were pooled by random-effects model. RESULTS:50 non-controlled observational studies were included, comprising a total of 10 066 patients with NICM. The percentage of appropriate shocks was 1% (87/7708; 95% CI 1% to 2%) in patients with NICM, 2% (16/1049; 95% CI 1% to 2%) in patients with myocarditis, 3% (7/183; 95% CI 0% to 20%) in peripartum cardiomyopathy, 2% (2/102; 95% CI 0% to 7%) in Takotsubo syndrome and 1% (8/594; 95% CI 1% to 3%) for congenital/inherited or genetic cardiomyopathy. Inappropriate shocks ranged from 0% to 1%. At the end of follow-up, between 6% (Takotsubo syndrome) and 43% (congenital/inherited or genetic cardiomyopathy) of patients received an ICD. CONCLUSION:Patients with NICM face a significant risk of SCD during the drug optimisation period before deciding if they qualify for ICD implantation. Results of this meta-analysis are based on non-comparative studies; however, the assessment of an appropriate shock delivered and recorded by the WCD is highly reliable. PROSPERO REGISTRATION NUMBER:CRD42024555879.

BACKGROUND AND AIMS:Current evidence on catheter ablation for patients with congenital heart disease (CHD) is derived from small, retrospective studies. This study aims to provide insights from a nationwide contemporary registry. METHODS:This prospective study included all CHD patients referred for catheter ablation from 2020 to July 2024 across 28 French centres. The primary outcome was the rate of per-procedural acute success. Secondary outcomes included complications as well as freedom from arrhythmia recurrence. RESULTS:A total of 1135 consecutive catheter ablation procedures were performed in 998 patients (mean age 46.1 ± 16 years, 55.5% male). The main primary clinical arrhythmias targeted were atrial flutter/tachycardia in 677 (59.6%), atrial fibrillation in 195 (17.2%), ventricular arrhythmia in 188 (16.6%), and atrioventricular reentrant tachycardia in 38 (3.3%), with significant variations in patterns observed based on the underlying substrate. Clinical arrhythmia was successfully ablated in 1071 patients (94.4%). The mean number of arrhythmias targeted per procedure was 1.5 ± 0.7, with overall acute success rates exceeding 90% for all arrhythmias except for ventricular arrhythmias (86.7%). Acute complication occurred in 43 procedures (3.8%), including 1 (0.1%) death. The overall 1- and 2-year recurrence-free rates were 77.3% (95% confidence interval 74.2%-80.4%) and 68.4% (95% confidence interval 64.7%-72.3%), respectively. Significant variations in recurrence rates were noted based on the type of arrhythmia and the underlying CHD. CONCLUSIONS:Catheter ablation in patients with CHD demonstrates highly favourable acute outcomes and a low complication rate. Recurrence rates during follow-up vary depending on the targeted arrhythmia and the underlying CHD. These findings should be considered in the benefit-risk assessment.

Background Recurrence rates of atrial arrhythmias after catheter ablation in patients with congenital heart disease (CHD) remain substantial. Given the high prevalence of peritricuspid flutter, systematic cavotricuspid isthmus (CTI) ablation may represent a rational preventive strategy. Objectives The objective of this study was to assess the impact of empirical CTI ablation in CHD patients. Methods This prospective nationwide study included all CHD patients referred for a first catheter ablation of an atrial arrhythmia between 2020 and 2024. Empirical ablation comprised probabilistic (noninducible arrhythmia with prior documentation) and prophylactic (no prior documentation) ablation. The primary endpoint was freedom from any atrial arrhythmia recurrence. Secondary endpoints included arrhythmia-related hospitalizations, redo ablations, and complications. Results Among 575 patients undergoing a first catheter ablation for atrial arrhythmia, 345 (60.0%) had CTI-dependent flutter. The remaining 230 patients formed the study population (mean age: 48.2 ± 16.4 years; 50.9% male). CHD complexity was predominantly moderate (57.4%). Targeted arrhythmias were atrial macro-re-entry (53.0%), atrial fibrillation (47.0%), and focal atrial tachycardia (17.4%), with multiple arrhythmias in 16.5%. Empirical CTI ablation was performed in 71 patients (30.9%) and was associated with significantly higher freedom from any atrial arrhythmia at 1 year (78.1% vs 65.6%, P = 0.010) and 2 years (71.2% vs 56.1%, P = 0.025), remaining independently associated with lower risk of recurrence after multivariable adjustment (HR: 0.47, 95% CI: 0.24-0.92, P = 0.027). This benefit was primarily observed in patients without atrial fibrillation history (interaction P = 0.005). Arrhythmia-related hospitalization was also significantly reduced (14.1% vs 25.8%, P = 0.048). Conclusions Empirical CTI ablation is associated with improved freedom from atrial arrhythmia and reduced rehospitalization in CHD patients.

PURPOSE:To design a deep learning pipeline for automated, time-resolved segmentation of the left atrium (LA) from 4D flow MRI data. METHODS:We studied 100 individuals including 65 patients with atrial fibrillation (AF) and 35 healthy subjects (HS) resulting in 2530 4D flow MRI time-volumes acquired in different centers and scanners. In AF patients, expert data annotation was initialized on a single frame of highly resolved computed tomography data and then registered (initialization frame), propagated through time and corrected manually on 4D flow MRI, while it was performed manually in HS. Segmentation pipeline was based on a two-stage nnU-Net and was evaluated through segmentation performance metrics, as well as concordance of LA volumes through time and inner LA hemodynamics between prediction and reference segmentations. RESULTS:Testing on 35 AF patients and 15 HS revealed high segmentation performances (overall Dice score = 0.89 ± 0.03 for the initialization frame and 0.86 ± 0.04 for all time frames; AF patient/HS- and vendor-based Dice scores ≥ 0.86 ± 0.03 for the initialization frame and ≥ 0.83 ± 0.04 for all time frames). Strong associations and low Bland-Altman biases were obtained between predicted and reference LA volumes (r ≥ 0.89), velocities (r ≥ 0.96), stasis (r ≥ 0.99), vorticity (r ≥ 0.97), and kinetic energy (r ≥ 0.94). Interestingly, associations remained strong when comparing prediction against 4D flow-independent cine SSFP-derived LA volumes (r ≥ 0.87). CONCLUSION:The proposed time-resolved nnU-Net pipeline robustly and accurately segments the LA from 4D flow MRI images demonstrating excellent segmentation performance, strong agreement with reference volumes and velocity-based indices, as well as reliable generalization across vendors and patient populations.

BACKGROUND:The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an established therapy for sudden cardiac death prevention, but sex-specific outcomes remain incompletely characterized. OBJECTIVES:This study evaluated sex-related differences in baseline characteristics, appropriate shocks, complications, reinterventions, and mortality among S-ICD recipients. METHODS:The nationwide HONEST (S-ICD French Cohort Study) cohort enrolled all patients who received an S-ICD in France between 2012 and 2019. Clinical endpoints were centrally adjudicated. Sex-specific associations with outcomes were assessed by using propensity score-based inverse probability weighting. RESULTS:Among 4,924 S-ICD recipients, 1,148 were women (23.3%). Compared with men, women were younger (47.3 ± 15.6 years vs 50.6 ± 14.7 years; P < 0.001), less frequently received an implant for primary prevention (57.6% vs 65.1%; P < 0.001), less often had coronary artery disease (38.9% vs 56.5%; P < 0.001), and more often had electrical heart disease (26.3% vs 20.4%; P < 0.001). After adjustment, women had a lower 5-year risk of appropriate shocks (HR: 0.85; 95% CI: 0.74-0.98; P = 0.023) and similar overall complication and reintervention rates but a distinct complication profile, with higher risks of chronic pain (HR: 2.63; 95% CI: 1.61-4.29; P < 0.001) and lead dislodgment (HR: 1.79; 95% CI: 1.09-2.95; P = 0.022) and a lower risk of inappropriate shocks (HR: 0.64; 95% CI: 0.50-0.82; P < 0.001). All-cause mortality was lower in women, whereas S-ICD-unresponsive sudden death and device-related mortality were similar. CONCLUSIONS:Women receiving an S-ICD experienced fewer appropriate shocks, with similar overall complication and reintervention rates, but a distinct complication profile. These findings support sex-informed S-ICD selection and follow-up. (S-ICD French Cohort Study [HONEST]; NCT05302115).

Background:Esophageal fistula (EF) is a rare but devastating complication following atrial fibrillation (AF) ablation. Data regarding the impact of age on EF are scarce. Objective:To study the impact of age on the management and prognosis of EF following catheter ablation for AF. Methods:The POTTER-AF study is a worldwide registry on EF following catheter ablation for AF. A total of 553,729 patients underwent AF ablation in 214 centers between 1996 and 2022. Of them, 138 patients experienced EF, and data regarding age, management, and prognosis were available in 113 patients. The population was divided based on the median age. Results:The median age was 63 years; 54 patients were <63 years old (Group 1), and 59 patients were ≥63 years old (Group 2). The groups were similar regarding procedural characteristics. The older population had a shorter time to symptom onset [15.0 (6.0, 21.0) vs. 21.0 (10.0, 25.3) days; p = 0.031]. Group 2 was less likely to receive a brain CT or MRI for diagnosis (25.9% vs. 45.3%; p = 0.046). The older population was more likely to undergo endoscopic treatment without surgery (27.6% vs. 11.3%; p = 0.035). Conservative and surgical treatments were used in similar proportions. A trend toward higher fatality was noted in the older patients (72.9% vs. 56.6%; p = 0.078). Conclusion:The older population had a shorter time to symptom onset, was less likely to receive a brain CT or MRI, and more likely to be treated by an endoscopic approach only. The older patient group showed a trend toward a higher fatality.

Leadless pacemakers (LP) have been recently developed to substitute transvenous pacemakers (TVP) when patients’ medical conditions prevent the use of TVP or suggest that TVP would be associated with high risk of lead- and pocket-related complications. LP may also improve patient safety and comfort by replacing surgery with a percutaneous procedure, eliminating the mass and scar visible at the TVP implantation site and eliminating the need for post-implant activity restrictions. A new ventricular (VR) LP system became available in 2023 in Europe; it features active fixation with helix, allows sensing/pacing parameters measures before LP fixation and it is upgradable to a dual chamber LP system. To evaluate the safety and performance of a new VR LP system in a population of 400 all-comers patients indicated for implantation of a VVI(R) pacemaker. French Cardiology Society is the sponsor of the France LEADLESS observational study which will involve all French sites implanting this new VR LP system. Patients will be followed for 2 years. We report preliminary analyses of clinical and electrical data collected at implant for 127 patients included between January 2024 and August 2024 at 16 French sites. 127 patients (36% female, mean age 74 years) have been so far included in the Registry. The most frequent patients’ comorbidities were hypertension in 75 (59%) patients and diabetes in 36 (27%) patients. The most frequent reported reasons to prefer a LP compared with TVP were high infectious risk in 53 (42%) patients, patient age in 37 (29%) patients, in particular in 16 (13%) young patients and in 21 (16%) old patients, limited venous access in 22 (17%) patients, previous infections in 16 (13%) patients, history of cancer in 13 (10%) patients, previous device/lead extraction in 13 (10%) patients, dialysis in 12 (9%) patients, patient choice in 9 (7%) patients, diabetes in 8 (6%) patients - taking into account that more than one reason could be associated to the same patient. Most frequent LP implant positions were mid-septum in 66 (52 %) patients and apical septum in the 52 (41%). Mean skin-to-skin procedure time was 44±18 minutes. Mean fluoroscopic time was 9±8 minutes. During implant the following complications occurred: pericardial effusion not requiring drainage in 1 (0.79%) patient, device dislodgement in 1 (0.79%) patient, fistula at femoral access in 1 (0.79%) patient treated with surgical intervention 6 days after. None of these events prevented successful implant. At implant, mean R wave sensing was 8±3 mV, mean impedance was 817±432 Ohm, mean threshold was 0.9±0.6 V at 0.4 ms. First real-world experience of a novel VR leadless pacemaker in France shows good safety profile, procedure times and electrical performances during implant. The most frequent reasons to choose a LP instead of a TVP were patients’ characteristics which predicted high infection risk.

Substrate ablation strategies in addition to pulmonary vein isolation (PVI) for the maintenance of sinus rhythm (SR) are still debated. Targeting low voltage areas (LVA) in addition to PVI may represent an efficient strategy for the ablation of persistent atrial fibrillation (AF). SCAR-AF study (ablation of LVA during sinus rhythm) was a multicenter, prospective, randomized trial, evaluating the effect of LVA ablation in addition to PVI for persistent AF on SR maintenance. From September 2019 to August 2021, patients with de novo persistent AF were included in the study. After LA mapping guided by a 3D mapping system, patients were divided according to the presence or absence of LVA. Patients without LVA were treated by PVI only (Group A). Patients with LVA were randomized to PVI only (Group B) or PVI + ablation of LVA (Group C). LVA was defined as voltage mapping with bipolar atrial voltage <0.5 mV. The primary endpoint was freedom from atrial arrhythmias, after a single ablation procedure. A total of 211 patients (Sex male: 73%, Mean Age 63.8+/-9.3 years, CHADS-VASC 2.1, long standing AF 33.5%). After 18 months FU, atrial-arrhythmia-free survival did not differ significantly between the 3 groups, 79% in Group A, 75.7% in Group B, 73.1% in Group C (Group A vs Group B: HR: 1.28; 95% CI: 0.64-2.55, p = .48, Group B vs Group C: HR 95%CI: 0.67-2.45; p = 0.45). Multivariate analysis showed that presence of LVA was associated with age (years) (HR 1.11 CI 1.06 – 1.16, p < 0.001) and inversely correlated with BMI (kg/m²) (HR 0.93, CI 0.87 – 0.99, p 0.029) and current smoking. In this randomized trial, PVI plus ablation of LVA did not significantly improved outcomes in patients with persistent AF. LVA may represent a marker of severe atrial cardiomyopathy.

AIMS:Cardiac resynchronization therapy (CRT) via biventricular pacing (BIVP) is an effective treatment, but non-responders are at a higher risk of death and heart failure (HF) hospitalizations compared with CRT responders. The MORE-CRT MPP trial aimed to evaluate whether CRT with multipoint pacing (MPP) is associated with improved clinical outcomes in CRT non-responders. METHODS AND RESULTS:Cardiac resynchronization therapy patients were treated with conventional BIVP for 6 months and then assessed for CRT response (left ventricular end-systolic volume relative reduction >15% vs. baseline). Cardiac resynchronization therapy non-responders were 1:1 randomized to BIVP or MPP and followed for 6 months. The main endpoint of this secondary analysis was HF hospitalizations or all-cause mortality. Of 3724 CRT patients (67 ± 11 years, 1050 female), 1677 were non-responders and randomized to MPP or BIVP, of whom 1421 (722 MPP and 699 BIVP) had complete data. In a mean follow-up of 5 ± 1 months after randomization, MPP was associated with a lower incidence of HF hospitalizations or all-cause mortality [48/722 (6.64%)] compared with BIVP (73/699 (10.44%), RRR = 36% (95% CI=±4%), P = 0.0107). At multivariable analysis, MPP was associated with a lower occurrence of the main endpoint (odds ratio = 0.60, P = 0.0124). At logistic regression analysis, HF hospitalizations or all-cause death were lower with MPP vs. BIVP in the whole population and in many patients subgroups, e.g. ischaemic patients and patients with long (>105 ms) interventricular electrical delay. CONCLUSION:In the MORE-CRT MPP randomized trial, MPP was associated with a significant reduction of all-cause mortality and HF hospitalizations in prior non-responders to conventional biventricular pacing.

BACKGROUND AND AIMS:Patients with newly diagnosed non-ischaemic cardiomyopathy (NICM) or myocardial infarction/coronary artery disease (MI/CAD) face an increased risk of sudden cardiac death (SCD) during the early phase of guideline-recommended medical therapy initiation and up-titration. Aim is to evaluate the risk in this population by assessing sudden cardiac arrest (SCA) due to ventricular tachycardia/ventricular fibrillation (VT/VF). METHODS:All patients in Germany who received a wearable cardioverter-defibrillator (WCD) between December 2021 and May 2023 were enrolled in the observational multicentre SCD-PROTECT study (NCT06883383). The primary outcome was the incidence of SCA due to sustained VT/VF, measured by appropriate WCD-delivered treatments, and reported as events per 100 patient-years with 95% confidence intervals (CI). Secondary outcomes included inappropriate WCD treatments, all-cause mortality, adverse events, adherence to WCD use, and heart failure medication patterns. RESULTS:In this cohort of 19 598 patients, the mean age (±standard deviation) was 58.6 ± 13.7 years for those with NICM and 64.2 ± 10.6 years for patients with MI/CAD. Female patients accounted for 23.8% of the NICM and 16.3% of the MI/CAD group. Left ventricular ejection fraction (LVEF) at study start was 26.9 ± 10.3% for NICM and 28.4 ± 8.0% for MI/CAD patients. The incidence rate of first appropriate treatment by WCD in NICM patients and MI/CAD patients was 6.10 (95% CI 5.31-7.00) and 8.64 (95% CI 7.41-10.05) events per 100 patient-years, respectively. Overall incidence density for all appropriate treatments was 8.53 (95% CI 7.36-9.88) and 14.98 (95% CI 12.69-17.65) per 100 patient-years in the respective groups. Improvement in LVEF to >35% was observed in 53.5% of NICM patients and 51.7% of MI/CAD patients over a mean of 65.9 ± 43.8 days. 36.2% of patients were implanted with a cardioverter-defibrillator at the end of WCD use. Total mortality was 0.8%. Inappropriate shocks occurred in 0.5% of patients. CONCLUSIONS:The SCD-PROTECT study highlights a substantial risk of SCA due to VT/VF during the early phase of guideline-recommended medical therapy optimization in patients with newly diagnosed reduced LVEF, regardless of ischaemic or non-ischaemic origin. The WCD provided SCD protection, the LVEF could improve to >35% in the majority of these patients and can therefore serve as risk stratification across both aetiologies.

BACKGROUND:Targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation (PVI) can improve ablation outcome in persistent atrial fibrillation (AF). OBJECTIVE:SCAR-AF was a multicenter, prospective, randomized trial, evaluating LVA ablation plus PVI for persistent AF. METHODS:Patients with de novo persistent AF were recruited (9 referral centers in France) into the SCAR-AF study (September 2019 to August 2021). Patients without LVA were treated with PVI alone (PVI-), and those with LVA were randomized to either PVI alone (PVI+) or PVI plus LVA ablation (PVI + LVA). The primary outcome was freedom from atrial arrhythmias (AF/atrial tachycardia) after a single procedure. RESULTS:A total of 211 patients (73.5% men, mean ± standard deviation age 63.8 ± 9.3 years, CHA2DS2-VASc score 2.1, long-standing AF 44.5%) were included. At 18-month follow-up, the incidence of atrial-arrhythmia-free survival did not differ between groups (79.0% in PVI-, 75.7% in PVI+, and 73.1% in PVI + LVA; PVI- vs PVI+, hazard ratio (HR) 1.28, 95% confidence interval [CI] 0.64-2.55, P = .48; PVI+ vs PVI + LVA, HR 1.28; 95% CI 0.67-2.45, P = .45). On multivariable analysis, presence of LVA was associated with advancing age (HR 1.11, 95% CI 1.06-1.16, P < .001) and was inversely correlated with body mass index (HR 0.93, 95% CI 0.87-0.99, P = .029) and smoking. CONCLUSION:In this randomized trial, PVI plus LVA ablation did not improve outcomes in patients with persistent AF. LVA may represent a marker of atrial cardiomyopathy, but its presence does not seem to be an effective target in persistent AF.

Background: Patient characteristics, technology and clinical practice surrounding primary prevention implantable cardioverter defibrillators have evolved continuously over time. Aim: To explore the temporal changes in patient characteristics, pharmacological therapy and device types among implantable cardioverter defibrillator recipients implanted for the primary prevention of sudden cardiac death over the last two decades in France. Methods: Characteristics of participants and type of device from the retrospective DAI-PP Pilot Study (2002-2012) were compared with those from the ongoing prospective DAI-PP Consortium (2018 onwards). Results: This study included 9588 participants overall (DAI-PP Pilot Study, n = 5539; DAI-PP Consortium, n = 4049). Compared with the DAI-PP Pilot Study, the DAI-PP Consortium subjects were older at implantation (62.5 vs 65.2 years; P = 0.001) and had a higher proportion of women (15.1% vs 20.6%; P < 0.001), a similar proportion of ischaemic heart disease (60.2% vs 60.2%; P = 0.98), a higher left ventricular ejection fraction (27 +/- 7% vs 30 +/- 8%; P < 0.001) and more patients with narrow QRS complexes (30.5% vs 46.0%; P < 0.001). The proportion of patients treated with heart failure drugs increased significantly (70.1% vs 83.1%; P < 0.001), whereas the use of amiodarone became much less frequent (22.7% vs 14.7%; P < 0.001). Finally, the proportions of cardiac resynchronization therapy defibrillators (53.8% vs 46.4%; P < 0.001) and dual-chamber defibrillators (23.3% vs 17.3%; P < 0.001) decreased, whereas subcutaneous implantable cardioverter defibrillators now account for a sizeable proportion of implants (14.6%). Conclusions: Over a 20-year period, the primary prevention implantable cardioverter defibrillator population has evolved significantly, with an older age and a higher proportion of women. The type of device has changed, with fewer cardiac resynchronization therapy defibrillators and more subcutaneous implantable cardioverter defibrillators. (c) 2025 Published by Elsevier Masson SAS.

Sustainability in healthcare, particularly within the domain of cardiac electrophysiology, assumes paramount importance for the near future. The escalating environmental constraints encountered necessitate a proactive approach. This position paper aims to raise awareness among physicians, spark critical inquiry and identify potential solutions to enhance the sustainability of our practice.Reprocessing of single-use medical devices has emerged as a potential solution to mitigate the environmental impact of electrophysiology procedures, while also offering economic advantages. However, reprocessing remains unauthorized in certain countries. In regions where it is possible, stringent regulatory standards must be adhered to, to ensure patient safety. It is essential that healthcare professionals, policymakers and manufacturers collaborate to drive innovation, explore sustainable practices and ensure that patient care remains uncompromised in the face of environmental challenges. Ambitious national/international programmes of disease prevention should be the cornerstone of the strategy. It is equally vital to implement immediate actions, as delineated in this position paper, to bring about tangible change quickly.

Background and Aims: Prophylactic implantable cardioverter-defibrillators (ICDs) are not recommended until left ventricular ejection fraction (LVEF) has been reassessed 40 to 90 days after an acute myocardial infarction. In the current therapeutic era, the prognosis of sustained ventricular arrhythmias (VAs) occurring during this early post-infarction phase (i.e. within 3 months of hospital discharge) has not yet been specifically evaluated in post-myocardial infarction patients with impaired LVEF. Such was the aim of this retrospective study. Methods: Data analysis was based on a nationwide registry of 1032 consecutive patients with LVEF <= 35% after acute myocardial infarction who were implanted with an ICD after being prescribed a wearable cardioverter-defibrillator (WCD) for a period of 3 months upon discharge from hospital after the index infarction. Results: ICDs were implanted either because a sustained VA occurred while on WCD (VA+/WCD, n = 72) or because LVEF remained <= 35% at the end of the early post-infarction phase (VA-/WCD, n = 960). The median follow-up was 30.9 months. Sustained VAs occurred within 1 year after ICD implantation in 22.2% and 3.5% of VA+/WCD and VA-/WCD patients, respectively (P < .0001). The adjusted multivariable analysis showed that sustained VAs while on WCD independently predicted recurrence of sustained VAs at 1 year (adjusted hazard ratio [HR] 6.91; 95% confidence interval [CI] 3.73-12.81; P < .0001) and at the end of follow-up (adjusted HR 3.86; 95% CI 2.37-6.30; P < .0001) as well as 1-year mortality (adjusted HR 2.86; 95% CI 1.28-6.39; P = .012). Conclusions: In patients with LVEF <= 35%, sustained VA during the early post-infarction phase is predictive of recurrent sustained VAs and 1-year mortality.