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(Circulation. 2006;114:1140-1145.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Familial Sudden Death Is an Important Risk Factor for Primary Ventricular Fibrillation

A Case-Control Study in Acute Myocardial Infarction Patients

Lukas R.C. Dekker, MD, PhD; Connie R. Bezzina, PhD; José P.S. Henriques, MD, PhD; Michael W. Tanck, PhD; Karel T. Koch, MD, PhD; Marco W. Alings, MD, PhD; Alfred E.R. Arnold, MD, PhD; Menko-Jan de Boer, MD, PhD; Anton P.M. Gorgels, MD, PhD; H. Rolf Michels, MD, PhD; Agnes Verkerk, BSc; Freek W.A. Verheugt, MD, PhD; Felix Zijlstra, MD, PhD; Arthur A.M. Wilde, MD, PhD

From Academic Medical Center (L.R.C.D., C.R.B., J.P.S.H., M.W.T., K.T.K., A.V., A.A.M.W.), Amsterdam, the Netherlands; Isala Hospitals (J.P.S.H., M.-J.d.B., F.Z.), Zwolle, the Netherlands; Amphia Hospital (M.W.A.), Breda, the Netherlands; Medical Center Alkmaar and Free University Medical Center (A.E.R.A.), Amsterdam, the Netherlands; Academic Hospital Maastricht (A.P.M.G.), Maastricht, the Netherlands; Catharina Hospital (H.R.M.), Eindhoven, the Netherlands; University Medical Center (F.W.A.V.), Nijmegen, the Netherlands; and University Medical Center Groningen (F.Z.), University of Groningen, Groningen, the Netherlands.

Correspondence to Dr L.R.C. Dekker, Department of Cardiology, B2-116, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. E-mail L.R.Dekker{at}amc.uva.nl

Received December 7, 2005; de novo received February 27, 2006; revision received June 1, 2006; accepted June 16, 2006.

Background— Primary ventricular fibrillation (VF) accounts for the majority of deaths during the acute phase of myocardial infarction. Identification of patients at risk for primary VF remains very poor.

Methods and Results— We performed a case-control study in patients with a first ST-elevation myocardial infarction (STEMI) to identify independent risk factors for primary VF. A total of 330 primary VF survivors (cases) and 372 controls were included; patients with earlier infarcts or signs of structural heart disease were excluded. Baseline characteristics, including age, gender, drug use, and ECG parameters registered well before the index infarction, as well as medical history, were not different. Infarct size and location, culprit coronary artery, and presence of multivessel disease were similar between groups. Analysis of ECGs performed at hospital admission for the index STEMI revealed that cumulative ST deviation was significantly higher among cases (OR per 10-mm ST deviation 1.59, 95% CI 1.25 to 2.02). Analysis of medical histories among parents and siblings showed that the prevalence of cardiovascular disease was similar between cases and controls (73.1% and 73.0%, respectively); however, familial sudden death occurred significantly more frequently among cases than controls (43.1% and 25.1%, respectively; OR 2.72, 95% CI 1.84 to 4.03).

Conclusions— In a population of STEMI patients, the risk of primary VF is determined by cumulative ST deviation and family history of sudden death.

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CLINICAL PERSPECTIVE

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