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C reactive protein is associated with malignant ventricular arrhythmias in patients with ischaemia with implantable cardioverter-defibrillator
  1. L M Biasucci,
  2. G Giubilato,
  3. G Biondi-Zoccai,
  4. T Sanna,
  5. G Liuzzo,
  6. M Piro,
  7. G De Martino,
  8. C Ierardi,
  9. A dello Russo,
  10. G Pelargonio,
  11. F Bellocci,
  12. F Crea
  1. Institute of Cardiology, Catholic University, Rome, Italy
  1. Correspondence to:
    Dr Luigi M Biasucci
    Institute of Cardiology, Catholic University, Largo F Vito 8, 00168 Rome, Italy; lmbiasucci{at}

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Patients with ischaemic heart disease and low ejection fraction (EF) are at increased risk of sudden death. MADIT (Multicenter Automated Defibrillator Implantation Trial) II has shown that implantable cardioverter-defibrillators (ICDs) reduce the risk of death by 31% at two years in patients with previous myocardial infarction and EF < 30%.1 The absolute risk reduction over an average follow up of 20 months, however, was only 5.6%. In addition, the high prevalence of patients who have had a myocardial infarction with EF ⩽ 30% makes the cost of this strategy high. This has led to an ongoing search for reliable markers of future episodes of life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) to identify a higher-risk subgroup in which ICD therapy can be more beneficial and cost effective.

The difficulty in predicting major ventricular arrhythmias probably reflects a limited understanding of their complex mechanisms. This is particularly true for patients who have had a myocardial infarction and with LV dysfunction, in whom myocardial ischaemia may trigger major ventricular arrhythmias. C reactive protein (CRP) concentration has been shown to be raised both in subjects studied …

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