Letter by Ravensbergen et al regarding article, "long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the cardiac arrhythmias and risk stratification after acute myocardial infarction (CARISMA) st

To the Editor: Patients who suffer a myocardial infarction (MI) are at risk of late sudden cardiac death. The underlying cause can be divided into 2 groups: recurrent acute MI or cardiac rupture, and arrhythmias.1 The second group might benefit from an implantable cardioverter-defibrillator, but identification of those patients who will benefit the most remains a continuous challenge. Recently, the 2-year follow-up of the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) trial was published in Circulation and commented on by Buxton.2 The study showed that, among 297 patients with a left ventricular ejection fraction ≤40% after an acute MI, a high-degree atrioventricular (AV) block was the most powerful predictor of cardiac death, and secondarily, the heart rate variability analysis in …