title: Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction.
abstract: OBJECTIVE
  To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF < or = 0.40).
  
  
  RESULTS
  A total of 5869 consecutive patients were screened in 10 European centres, and 312 patients (age 65 +/- 11 years) with a mean LVEF of 31 +/- 6% were included in the study. Heart rate variability/turbulence, ambient arrhythmias, signal-averaged electrocardiogram (SAECG), T-wave alternans, and programmed electrical stimulation (PES) were performed 6 weeks after AMI. The primary endpoint was ECG-documented ventricular fibrillation or symptomatic sustained ventricular tachycardia (VT). To document these arrhythmic events, the patients received an implantable ECG loop-recorder. There were 25 primary endpoints (8.0%) during the follow-up of 2 years. The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms(2)) adjusted for clinical variables was 7.0 (95% CI: 2.4-20.3, P < 0.001). Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7-13.4, P = 0.003) also predicted the primary endpoint.
  
  
  CONCLUSIONS
  Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI.
authors.affiliation: Department of Internal Medicine, University of Oulu, PO Box 5000, Kajaanintie 50, 90014 Oulu, Finland. heikki.huikuri@oulu.fi
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
authors.forename: M J Pekka
authors.initials: MJ
authors.lastname: Raatikainen
authors.forename: Rikke
authors.initials: R
authors.lastname: Moerch-Joergensen
authors.forename: Juha
authors.initials: J
authors.lastname: Hartikainen
authors.forename: Vesa
authors.initials: V
authors.lastname: Virtanen
authors.forename: Jean
authors.initials: J
authors.lastname: Boland
authors.forename: Olli
authors.initials: O
authors.lastname: Anttonen
authors.forename: Nis
authors.initials: N
authors.lastname: Hoest
authors.forename: Lucas V A
authors.initials: LV
authors.lastname: Boersma
authors.forename: Eivind S
authors.initials: ES
authors.lastname: Platou
authors.forename: Marc D
authors.initials: MD
authors.lastname: Messier
authors.forename: Poul-Erik
authors.initials: PE
authors.lastname: Bloch-Thomsen
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000628:therapy; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D017180:Tachycardia, Ventricular / Q000175:diagnosis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000175:diagnosis