Implantable cardioverter defibrillator following acute myocardial infarction: the '48-hour' and '40-day' rule

Until recently, randomized studies of implantable cardioverterdefibrillator (ICD) have only included patients with a remotehistory of myocardial infarction (MI). Two studies evaluatedthe use of ICDs early following MI, the DINAMIT and BEST+ICDstudies, but failed to demonstrate significant reduction inmortality. Current guidelines therefore recommend deferringICD implantation for at least 40 days following MI. This articlehighlights the limitations of these two studies and reviewsthe application of the ‘40-day’ rule to patientswith acute MI.