Risk of ventricular arrhythmias in survivors of myocardial infarction.
The most recent studies have made it clear that the prognosis of asymptomatic post-MI patients has significantly improved in the last two decades. Holter monitoring as well as a low LVEF still is an important method for the risk stratification in the thrombolytic era of patients with post-MI. Patients with normal noninvasive tests do have a good prognosis. The electrophysiological stimulation seems to be the clinically most valuable single method to predict arrhythmic events. However, as an invasive procedure it is not suitable as a screening test for a large cohort. The stepwise risk stratification technique using first noninvasive followed by invasive procedures seem to be most suitable and effective for identifying asymptomatic infarct survivors which incidence of arrhythmic events is as high as the recurrence rate of patients who had been resuscitated from ventricular fibrillation. Consequently, prophylactic implantation of a defibrillator in asymptomatic MI patients, whose positive predictive value is around 30% becomes more and more interesting.
Andresen
D
D
Division of Cardiology, Klinikum Benjamin Franklin, Free University of Berlin, Germany.
Brüggemann
T
T
Behrens
S
S
Ehlers
C
C
D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted