Identification of sudden death risk factors in acute and chronic coronary artery disease

Clinical Applications of Ambulatory Electrocardiography

“…7). Present most typically is ischemic heart disease or other types of car diomyopathy leading to congestive heart fail ure [100,101], although potentially lethal ar rhythmias may be seen in the localized disor der of arrhythmogenic right ventricular dys plasia [102,103], Recurrence of potentially fatal arrhythmias is more common when unassociated with acute myocardial infarction [104], a finding consistent with the prognostic ambiguity of early, as opposed to late phase, infarction arrhythmias [27], Hemodynamic profiles of patients resusci tated from out of hospital cardiac arrest re veal reduced cardiac index and ejection frac tion in the majority, but normal left ventric ular function in as many as one-third of this group [93], Ambulatory electrocardiography in 144 survivors of prehospital ventricular fibrillation reported by Weaver et al [105] revealed multiform ventricular ectopy in over three-fourths, VPC couplets or triplets in over half, and nonsustained ventricular tachycardia in nearly 10% of this population. Subsequent sudden death was most accu rately predicted by frequent multiform VPCs, bigeminy or trigeminy, and sequential forms, but not by frequency of simple VPCs alone.…”

“…Assessing 8-hour taped electrocardiograms in 64 patients dur ing the late hospital recovery phase of infarc tion. Vismara et al [27] found no 2-year sud den death in patients without VPCs, but ob served the occurrence of sudden death in 22% with simple VPCs and in 35% with more complex VPC forms, which included VPCs more frequent than 5 per minute as well as multiform, sequential, and early-cycle VPCs. This study also made the important observation that arrhythmias occurring only in the coronary care unit during the acute phase of myocardial infarction, if survived, confer no additional adverse risk.…”

Effect of electrocardiographic recording duration on ventricular dysrhythmia detection after myocardial infection.

“…A standard 12-lead ECG is quite insensitive in detecting cardiac arrhythmias4 8,10,11 and a longer duration of recording is required. Kotler and associates4 reported that analysis of four recordings with standard 12-lead ECGs identified more than twice as many patients with ventricular arrhythmias as did single-recording analysis (35% vs 15%).…”

“…Extended electrocardiographic recording over several hours is now widely used to evaluate patients at high risk of sudden cardiac death. 4 [6][7][8] However, the most effective duration of this recording has not been determined. This study was undertaken to evaluate the effect of varying recording periods on the detection of ventricular ectopic activity in survivors of myocardial infarction.…”

The prolonged QT interval—a frequently unrecognized abnormality

“…In patients with coronary heart disease, ventricular ectopics are associated with an increased risk of sudden cardiac death (Vismara et al, 1977;Chiang et al, 1969;Oliver et al, 1974). Yet a majority of middle aged adults with no apparent heart disease have dysrhythmias with little effect on mortality (Clarke et al, 1976;Pribble et al, 1975;Desai et al, 1973).…”