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Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction.

Huikuri HV, Raatikainen MJ, Moerch-Joergensen R, Hartikainen J, Virtanen V, Boland J, Anttonen O, Hoest N, Boersma LV, Platou ES, Messier MD, Bloch-Thomsen PE, Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction study gro - Eur. Heart J. (2009)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Oulu, PO Box 5000, Kajaanintie 50, 90014 Oulu, Finland. heikki.huikuri@oulu.fi

ABSTRACT

Aims: 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).

Methods and 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.

Conclusion: 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.

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Related in: MedlinePlus

Clinical presentation, type of documented arrhythmia, and the mode of documentation of primary endpoints. ICD, implantable cardioverter-defibrillator; ILR, implantable loop-recorder; VT, ventricular tachycardia; VF, ventricular fibrillation.
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EHN537F2: Clinical presentation, type of documented arrhythmia, and the mode of documentation of primary endpoints. ICD, implantable cardioverter-defibrillator; ILR, implantable loop-recorder; VT, ventricular tachycardia; VF, ventricular fibrillation.

Mentions: Of the 312 enrolled patients, 25 (8.0%) experienced a primary endpoint during the follow-up. Twelve of these were symptomatic sustained monomorphic VTs, eight were sudden deaths, three aborted cardiac arrests, and two patients had syncope before termination of VF by ICD shock. The clinical presentation, type of documented arrhythmia, and the mode of diagnosing the primary endpoints are shown in FigureĀ 2. Ten out of the 12 sustained VTs were documented by the ILR and two by the ICD. Six sudden deaths were due to VF, four documented by the ILR, and two by ECG strip obtained by telemetry. Two sudden deaths were preceded by fast VT, one documented by the ILR, and one by telemetry strip. Two patients with resuscitated cardiac arrest had VF and one had fast VT. The arrhythmia was terminated by the external DC shock among these three patients. Two of these were documented by the ILR and one occurred during the Holter recording. VT (n = 3) or VF (n = 4) was documented by the ILR in seven patients, in whom the documented arrhythmias were not considered as primary endpoints. Five of these occurred among patients hospitalized due to terminal heart failure, one occurred in a patient dying for acute heart failure, and one occurred in a hospitalized patient with a recurrent AMI associated with frequent VF episodes not responding to DC shocks and resuscitation attempts.


Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction.

Huikuri HV, Raatikainen MJ, Moerch-Joergensen R, Hartikainen J, Virtanen V, Boland J, Anttonen O, Hoest N, Boersma LV, Platou ES, Messier MD, Bloch-Thomsen PE, Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction study gro - Eur. Heart J. (2009)

Clinical presentation, type of documented arrhythmia, and the mode of documentation of primary endpoints. ICD, implantable cardioverter-defibrillator; ILR, implantable loop-recorder; VT, ventricular tachycardia; VF, ventricular fibrillation.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2655314&req=5

EHN537F2: Clinical presentation, type of documented arrhythmia, and the mode of documentation of primary endpoints. ICD, implantable cardioverter-defibrillator; ILR, implantable loop-recorder; VT, ventricular tachycardia; VF, ventricular fibrillation.
Mentions: Of the 312 enrolled patients, 25 (8.0%) experienced a primary endpoint during the follow-up. Twelve of these were symptomatic sustained monomorphic VTs, eight were sudden deaths, three aborted cardiac arrests, and two patients had syncope before termination of VF by ICD shock. The clinical presentation, type of documented arrhythmia, and the mode of diagnosing the primary endpoints are shown in FigureĀ 2. Ten out of the 12 sustained VTs were documented by the ILR and two by the ICD. Six sudden deaths were due to VF, four documented by the ILR, and two by ECG strip obtained by telemetry. Two sudden deaths were preceded by fast VT, one documented by the ILR, and one by telemetry strip. Two patients with resuscitated cardiac arrest had VF and one had fast VT. The arrhythmia was terminated by the external DC shock among these three patients. Two of these were documented by the ILR and one occurred during the Holter recording. VT (n = 3) or VF (n = 4) was documented by the ILR in seven patients, in whom the documented arrhythmias were not considered as primary endpoints. Five of these occurred among patients hospitalized due to terminal heart failure, one occurred in a patient dying for acute heart failure, and one occurred in a hospitalized patient with a recurrent AMI associated with frequent VF episodes not responding to DC shocks and resuscitation attempts.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Oulu, PO Box 5000, Kajaanintie 50, 90014 Oulu, Finland. heikki.huikuri@oulu.fi

ABSTRACT

Aims: 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).

Methods and 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.

Conclusion: 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.

Show MeSH
Related in: MedlinePlus