title: The role of silent ischemia, the arrhythmic substrate and the short-long sequence in the genesis of sudden cardiac death.
abstract: To study the role of silent ischemia and the arrhythmic substrate in the genesis of sudden cardiac death, 67 patients were studied (mean age 62 +/- 12 years). Of these, 14 patients (Group 1) had an in-hospital episode of ventricular tachycardia or fibrillation while wearing a 24 h Holter ambulatory electrocardiographic (ECG) monitor, 33 (Group II) had a documented episode of sustained ventricular tachycardia or fibrillation, or both, and 20 (Group III) had angina pectoris but no ventricular tachycardia or fibrillation. Eight Group I survivors underwent programmed electrical stimulation or ECG signal averaging, or both. All Group II patients underwent 24 h Holter monitoring and ECG signal averaging to detect late potentials before programmed electrical stimulation. Group III patients underwent both 24 h Holter recording and coronary angiography. The 24 h ECG tapes were analyzed for ST segment changes, prematurity index and characteristics of ventricular premature depolarizations. Any ST depression greater than or equal to 1 mm for greater than 30 s was considered to be a reflection of silent ischemia, and the induction of ventricular tachycardia or fibrillation by programmed electrical stimulation or the presence of late potentials, or both, was considered to be a reflection of the arrhythmia substrate. Silent ischemia preceded ventricular tachycardia in only 2 (14%) of the 14 Group I patients. The prematurity index was less than 1 in only 18% of ventricular tachycardia episodes.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, Mount Sinai School of Medicine, City University of New York, New York.
authors.forename: J A
authors.initials: JA
authors.lastname: Gomes
authors.forename: D
authors.initials: D
authors.lastname: Alexopoulos
authors.forename: S L
authors.initials: SL
authors.lastname: Winters
authors.forename: P
authors.initials: P
authors.lastname: Deshmukh
authors.forename: V
authors.initials: V
authors.lastname: Fuster
authors.forename: K
authors.initials: K
authors.lastname: Suh
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications*; D003645:Death, Sudden / Q000209:etiology*; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D013610:Tachycardia / Q000209:etiology; D014693:Ventricular Fibrillation / Q000209:etiology