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


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.
Richards
D A
DA
Cardiology Unit, Westmead Hospital, New South Wales, Australia.
Byth
K
K
Ross
D L
DL
Uther
J B
JB
D000368:Aged; D002304:Cardiac Pacing, Artificial; D015331:Cohort Studies; D003645:Death, Sudden / Q000453:epidemiology*; D004594:Electrophysiology; D006334:Heart Function Tests; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011237:Predictive Value of Tests; D011379:Prognosis; D013610:Tachycardia / Q000453:epidemiology* / Q000209:etiology; D014693:Ventricular Fibrillation / Q000453:epidemiology*; D016277:Ventricular Function, Left / Q000502:physiology