This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Richards, D. A. Articles by Uther, J. B. Search for Related Content PubMed PubMed Citation Articles by Richards, D. A. Articles by Uther, J. B.

Circulation, Vol 83, 756-763, Copyright © 1991 by American Heart Association

ARTICLES

What is the best predictor of spontaneous ventricular tachycardia and sudden death after myocardial infarction?

DA Richards, K Byth, DL Ross and JB Uther
Cardiology Unit, Westmead Hospital, New South Wales, Australia.

BACKGROUND. Death during the first year after myocardial infarction is most commonly due to spontaneous ventricular tachycardia (VT) or fibrillation (VF). The purpose of this study was to compare, in a single cohort of patients, the values of inducible VT, delayed ventricular activation, low left ventricular ejection fraction, high- grade ventricular ectopy, and ST segment displacement on exercise in predicting electrical events (witnessed instantaneous death and spontaneous VT or VF) during the first year after myocardial infarction. METHODS AND RESULTS. Three hundred sixty one patients aged less than 71 years underwent electrophysiological study, signal- averaged electrocardiogram, gated blood-pool scan, 24 hour ambulatory electrocardiographic monitoring, and exercise testing 1-2 weeks after myocardial infarction and were then followed up for at least 1 year. There were 34 deaths (eight witnessed instantaneous, 26 other), and nine patients survived one or more episodes of spontaneous VF or VT. Patients with inducible VT were 15.2 times more likely to suffer electrical events than patients without inducible VT. No proportional- hazards model excluding inducible VT was as good a predictor of electrical events as was inducible VT alone. CONCLUSIONS. Inducible VT at electrophysiological study was the single best predictor of spontaneous VT and sudden death after myocardial infarction.

This article has been cited by other articles:

				N Elgarhi, J Kreuz, O Balta, G Nickenig, H Hoium, T Lewalter, and J O. Schwab Significance of Wedensky Modulation testing in the evaluation of non-invasive risk stratification for ventricular tachyarrhythmia in patients with coronary artery disease and implantable cardioverter-defibrillator Heart, April 1, 2008; 94(4): e16 - e16. [Abstract] [Full Text] [PDF]

				M. R. Reynolds and M. E. Josephson MADIT II (Second Multicenter Automated Defibrillator Implantation Trial) Debate: Risk Stratification, Costs, and Public Policy Circulation, October 14, 2003; 108(15): 1779 - 1783. [Full Text] [PDF]

				H. V. Huikuri, T. H. Makikallio, M. J. P. Raatikainen, J. Perkiomaki, A. Castellanos, and R. J. Myerburg Prediction of Sudden Cardiac Death: Appraisal of the Studies and Methods Assessing the Risk of Sudden Arrhythmic Death Circulation, July 8, 2003; 108(1): 110 - 115. [Full Text] [PDF]

				J. J. Bailey, A. S. Berson, H. Handelsman, and M. Hodges Utility of current risk stratification tests for predicting major arrhythmic events after myocardial infarction J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1902 - 1911. [Abstract] [Full Text] [PDF]

				F. Paganelli, P. Barnay, I. Imbert-Joscht, R. Gelisse, A. Saadjian, O. Mundler, and S. Levy Influence of residual myocardial ischaemia on induced ventricular arrhythmias following a first acute myocardial infarction Eur. Heart J., October 2, 2001; 22(20): 1931 - 1937. [Abstract] [PDF]

				S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]

				C. Schmitt, P. Barthel, G. Ndrepepa, J.u. Schreieck, A. Plewan, A. Schomig, and G. Schmidt Value of programmed ventricular stimulation for prophylactic internal cardioverter-defibrillator implantation in postinfarction patients preselected by noninvasive risk stratifiers J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1901 - 1907. [Abstract] [Full Text] [PDF]

				A. E. Buxton, K. L. Lee, L. DiCarlo, M. R. Gold, G. S. Greer, E. N. Prystowsky, M. F. O'Toole, A. Tang, J. D. Fisher, J. Coromilas, et al. Electrophysiologic Testing to Identify Patients with Coronary Artery Disease Who Are at Risk for Sudden Death N. Engl. J. Med., June 29, 2000; 342(26): 1937 - 1945. [Abstract] [Full Text] [PDF]

				R M Norris CORONARY DISEASE: The natural history of acute myocardial infarction Heart, June 1, 2000; 83(6): 726 - 726. [Full Text]

				M. H. Crawford, S. J. Bernstein, P. C. Deedwania, J. P. DiMarco, K. J. Ferrick, A. Garson Jr, L. A. Green, H. L. Greene, M. J. Silka, P. H. Stone, et al. ACC/AHA guidelines for ambulatory electrocardiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography) developed in collaboration with the North American Society for Pacing and Electrophysiology J. Am. Coll. Cardiol., September 1, 1999; 34(3): 912 - 948. [Full Text] [PDF]

				A. E. Buxton, G. E. Hafley, M. H. Lehmann, M. Gold, M. O'Toole, A. Tang, J. Coromilas, B. Hook, N. J. Stamato, and K. L. Lee Prediction of Sustained Ventricular Tachycardia Inducible by Programmed Stimulation in Patients With Coronary Artery Disease : Utility of Clinical Variables Circulation, April 13, 1999; 99(14): 1843 - 1850. [Abstract] [Full Text] [PDF]

				D. Andresen, G. Steinbeck, T. Bruggemann, D. Muller, R. Haberl, S. Behrens, E. Hoffmann, K. Wegscheider, R.u. Dissmann, and H.-C. Ehlers Risk stratification following myocardial infarction in the thrombolytic era: a two-step strategy using noninvasive and invasive methods J. Am. Coll. Cardiol., January 1, 1999; 33(1): 131 - 138. [Abstract] [Full Text] [PDF]

				K. H. Newby, T. Thompson, A. Stebbins, E. J. Topol, R. M. Califf, and A. Natale Sustained Ventricular Arrhythmias in Patients Receiving Thrombolytic Therapy : Incidence and Outcomes Circulation, December 8, 1998; 98(23): 2567 - 2573. [Abstract] [Full Text] [PDF]

				P. Savard, J.-L. Rouleau, J. Ferguson, N. Poitras, P. Morel, R. F. Davies, D. J. Stewart, M. Talajic, M. Gardner, R. Dupuis, et al. Risk Stratification After Myocardial Infarction Using Signal-Averaged Electrocardiographic Criteria Adjusted for Sex, Age, and Myocardial Infarction Location Circulation, July 1, 1997; 96(1): 202 - 213. [Abstract] [Full Text]

				S. Saksena and I. Giorgberidze The Multicenter Automatic Defibrillator Implantation Trial: MADIT Provides the Basis for Developing Therapeutic Strategy for Patients With Severely Depressed Ventricular Ejection Fraction With Nonsustained Ventricular Tachycardia Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1997; 2(3): 229 - 234. [PDF]

				W. G. Stevenson and P. M. Ridker Should Survivors of Myocardial Infarction With Low Ejection Fraction Be Routinely Referred to Arrhythmia Specialists? JAMA, August 14, 1996; 276(6): 481 - 485. [Abstract] [PDF]

				D. S. Rosenbaum, L. E. Jackson, J. M. Smith, H. Garan, J. N. Ruskin, and R. J. Cohen Electrical Alternans and Vulnerability to Ventricular Arrhythmias N. Engl. J. Med., January 27, 1994; 330(4): 235 - 241. [Abstract] [Full Text]

				IS ELECTROPHYSIOLOGY TESTING THE BEST PREDICTOR OF DEATH AFTER MI Journal Watch (General), March 19, 1991; 1991(319): 6 - 6. [Full Text]