Circulation, Vol 74, 731-745, Copyright © 1986 by American Heart Association
AR Denniss, DA Richards, DV Cody, PA Russell, AA Young, MJ Cooper, DL Ross and JB Uther
The relative prognostic significance of ventricular tachycardia and
ventricular fibrillation inducible at programmed stimulation within 1 month
of acute myocardial infarction was compared in a prospective study of 403
clinically well survivors of transmural infarction who were 65 years old or
younger. The prognostic significance of delayed potentials on the
signal-averaged electrocardiogram was also examined in a subset of 306
patients without bundle branch block. Among the study patients, 20% had
inducible ventricular tachycardia, 14% had inducible ventricular
fibrillation, and 66% had no inducible arrhythmias. The 2 year probability
of remaining free from cardiac death or nonfatal ventricular tachycardia or
fibrillation was 0.73 for those with inducible ventricular tachycardia,
0.93 for those with inducible ventricular fibrillation, and 0.92 for those
with no inducible arrhythmias. The cycle length of inducible ventricular
tachycardia was 230 msec or more in 70% of the patients with inducible
tachycardia who died. Of the patients studied by signal-averaged
electrocardiography, 26% had delayed potentials. At 2 years, the
probability of remaining free from cardiac death or nonfatal ventricular
tachycardia or fibrillation was 0.73 for patients with delayed potentials
and 0.95 for patients with no delayed potentials. There was a significant
correlation (p less than .001) between the presence of delayed potentials
and the ability to induce ventricular tachycardia. In conclusion, in
survivors of recent infarction who have not had spontaneous ventricular
tachycardia or fibrillation, inducible tachycardia (but not inducible
fibrillation) at programmed stimulation predicts a significant risk of
death or spontaneous tachycardia or fibrillation. A similar risk is found
for patients with delayed potentials on the signal-averaged
electrocardiogram.
ARTICLES
Prognostic significance of ventricular tachycardia and fibrillation induced at programmed stimulation and delayed potentials detected on the signal-averaged electrocardiograms of survivors of acute myocardial infarction
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