Relationship between Ventricular Premature Contractions on Routine Electrocardiography and Subsequent Sudden Death from Coronary Heart Disease

Fisher, F. David; Tyroler, Herman A.

doi:10.1161/01.cir.47.4.712

Cited by 77 publications

(18 citation statements)

References 11 publications

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“…Although much attention has been given to the problem of prehospital SCD,'"-' [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] several important areas remain poorly defined. These include: (1) conjectural, and information concerning rhythms which precede those monitored by rescue workers is not available.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

et al. 1974

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SUMMARYIn order to better understand the problem of prehospital sudden cardiac death (SCD) two groups of individuals were studied. One group was monitored by rescue squads during attempted rescue. These subjects were defibrillated from prehospital ventricular fibrillation (VF) and hospitalized if they survived or autopsied if they could not be resuscitated. The second group were SCDs which were witnessed and described by observers. Detailed past histories of both groups were collected, and either clinical or autopsy diagnoses were obtained.On the day of death or VF, one quarter reported new symptoms (primarily chest pain and dyspnea) preceding collapse by more than 30 minutes, one quarter reported symptoms lasting from 1 to 30 minutes, and one half collapsed instantaneously or within 1 minute of acute symptoms. A history of old myocardial infarction (MI) was present in 41% and of angina pectoris in 54%, and 27% reported new or changing symptoms within four weeks.In defibrillated survivors, "'would-be SCDs,-electrocardiographic (ECG) changes of acute myocardial infarction (AMI) or ischemia were nearly three times more frequent than changes detected histologically in SCDs, and in the former involved predominantly the anterior wall in contrast to the inferior wall in most autopsied deaths. This disparity implicates acute myocardial lesions, particularly of the anterior wall, in the majority of SCDs.Acute coronary lesions were found in 58% of SCDs autopsied. Most of these were ruptured plaquealthough almost one fifth of all autopsied SCDs had thromboses without intimal rupture. Severe chronic multivessel stenosis was present in most subjects, although 15% had only disease of a single vessel and in these, the left anterior descending (LAD) or left main coronary artery were involved in three quarters.The SCD population may be subgrouped into those with recent MI, those with only myocardial ischemia, and those with no detectable myocardial change. When rescuers were able to monitor prehospital SCDs, VF was found in the majority; however, 28% did have other terminal rhythms.

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Section: Discussionmentioning

confidence: 99%

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

et al. 1974

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“…The diagnosis of acute myocardial infarction was based on clini cal (typical chest pain lasting >30 min), electrocardiographic (new Several studies have shown increased mortality associ ated with ventricular ectopic activity in survivors from acute myocardial infarction [1][2][3][4][5][6][7], In some previous stud ies, follow-up was relatively short, patient groups were rel atively small and arrhythmias were detected on standard electrocardiograms only. This report focuses on the 10-year prognostic significance of ventricular ectopic activity in a large cohort of patients (n = 1,737) after myocardial infarction who underwent 24-hour Holter monitoring be tween 7 and 21 (mean 12) days after the acute event.…”

Section: Introduction Methodsmentioning

confidence: 99%

The Long-Term Prognostic Significance of High-Grade Ventricular Ectopic Activity in Survivors of Acute Myocardial Infarction

Behar¹,

Kaplinsky²,

Zion³

et al. 1994

Am J Noninvas Cardiol

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Previous studies have shown increased mortality related to ventricular ectopic activity in survivors from acute myocardial infarction. This report focuses on the 10-year prognostic significance of ventricular ectopic activity among 1,737 patients with acute myocardial infarction who underwent 24-hour Holter monitoring between 7 and 21 (mean 12) days after the infarction. Among this group of patients, 573 (33%) were free from ventricular ectopic activity, 670 (39%) had Lown grade 1-2 and 455 (26%) Lown grade 3-4 premature ventricular contractions. Thirty-nine patients (2%) exhibited ventricular tachycardia. The distribution of ventricular ectopic activity was similar among men and women, but increased significantly with age, previous history of myocardial infarction, and higher Killip class, as well as among patients with very high enzyme levels. Multivariate analysis adjusted for clinical and Holter variables showed that ventricular tachycardia was an independent predictor for 1-year mortality (relative risk 2.70; 90% confidence interval 1.19-6.19) but its effect diminished to some extent 10 years later (relative risk 1.39; 90% confidence interval 0.94-2.06). Frequent premature ventricular contractions (Lown grade 3-4) were associated with somewhat increased risk for 10-year mortality (relative risk 1.21, 90% confidence interval 1.04-1.41). Although the mechanisms by which ventricular ectopic activity increases subsequent mortality have not been completely elucidated, the results of this study suggest that ectopic ventricular activity is an independent contributor to the excess mortality observed in these patients.

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“…But, PVCs may still have an important role in risk stratification even if treatment with antiarrhythmic medications is not appropriate. A higher prevalence of PVCs has been seen in patients with coronary artery disease (Bikkina, Larson, & Levy, 1992), hypertension (Vogt et al, 1990), accompanying ECG abnormalities (Fisher & Tyroler, 1973), and nearly every form of structural heart disease. PVCs also increase with age (Flegg, 1988;Kostis et al, 1982).…”

Section: Pvcsmentioning

confidence: 99%

“…The 4% prevalence of PVCs found in our study compares favorably with a rate of 2-7% in previous epidemiologic studies including those using 2-min rhythm strips. (Crow et al, 1975;Fisher & Tyroler, 1973;Kostis et al, 1987;Simpson et al, 200). Overall, this is a retrospective analysis and, as such, should be considered hypothesis generating rather than conclusive evidence of a cause and effect relationship.…”

Section: Study Limitationsmentioning

confidence: 99%

The Prevalence and Prognostic Value of Rest Premature Ventricular Contractions

Solomon¹,

Froelicher²

2012

Advances in Electrocardiograms - Clinical Applications

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Relationship between Ventricular Premature Contractions on Routine Electrocardiography and Subsequent Sudden Death from Coronary Heart Disease

Cited by 77 publications

References 11 publications

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

The Long-Term Prognostic Significance of High-Grade Ventricular Ectopic Activity in Survivors of Acute Myocardial Infarction

The Prevalence and Prognostic Value of Rest Premature Ventricular Contractions

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