Importance of quantitative analysis of ventricular arrhythmias for predicting the prognosis in low-risk postmyocardial infarction patients

Abstract

In 378 placebo patients enrolled in the European Infarction Study (EIS), a secondary prevention study after acute myocardial infarction, 24-h baseline Holter monitoring was done 14 to 31 days after MI, and the relationship of electrical (ventricular arrhythmias) and mechanical (clinical signs of ventricular dysfunction) risk factors was analysed on the basis of mortality during the subsequent 2 years of follow-up. There was a rather low overall 2-year mortality rate of 6.9%. Consecutive arrhythmias (ventricular pairs and runs of ventricular premature beats) and left-ventricular dysfunction alone were associated with a low mortality of 4.0% and 3.6%, respectively. However, the combination of both defined a high-risk group characterized by a 2-year mortality rate of 16.7%. Additionally, the risk of dying was dependent on the frequency of consecutive arrhythmias: 22.2% of the patients with greater than 10 ventricular pairs per day died during the follow-up period in contrast to 9.9% of those with only 1-10 ventricular pairs per day. Thus, only the combination of electrical and mechanical risk factors, and especially the frequency of consecutive VPB, is helpful in identifying a subgroup of postMI patients with poor clinical outcome. An intervention study should restrict itself to this risk population only.

Prognostic implications of ventricular ectopy one week, one month, and sixteen months after an acute myocardial infarction

“…In patients with < 10 VPCsh in one recording. registration of> 10 VPCs/h was assessed in a later recording. This evaluation took place in 169 patients from the first to the second recording, in I5 1 patients from the first to the hird recording, and in 126 patients from the second to the third recording.…”

Refractory electrical storm in coronary artery disease patient, challenges of dying heart

“…The risk of VT is highest during the fi rst year (3-5%) following acute MI [1], as well as the risk of sudden death from ventricular dysrhythmias remains high and may increase with time [2]. This patient developed MI several years before presentation, generally, the triggering mechanism for VT and particularly for ES is not well understood and it might be the main limitation for the development of a new clinically effective anti-dysrhythmic drug.…”

Epidemiologie des plötzlichen Herztodes

“…In zahlreichen Studien kamen nicht-invasive und invasive Methoden zur Anwendung, mit denen der prognostische Wert verschiedener Risikoparameter geprüft wurde (Abb. 3) (3,5,2,15,17). Im Wesentlichen sind dies die Beurteilung der klinischen Funktionalität entsprechend der NYHA-Klassifikation, die Quantifizierung der linksventrikulären Pumpfunktion mittels Bestimmung der Auswurffraktion (EF) (7), elektrokardiographische Methoden wie das Langzeit-EKG (19), die Spätpotentialanalyse (25) und andere, die Objektivierung der autonomen Dysfunktion anhand der Herzfrequenzvariabilität (14, 6), der Chemo-oder Baroreflexsensitivität (11,16) die Interpretation der Repolarisation mittels T-Wellen-Analyse (22, 23) sowie die invasive elektrophysiologische Untersuchung (24).…”