Prognostic Significance of Ventricular Ectopic Beats with Respect to Sudden Death in the Late Postinfarction Period

The role of ventricular dysrhythmias as determinants of sudden coronary death (SCD) was studied prospectively in 160 male survivors of myocardial infarction, all under 65 years of age and in New York Heart Association (NYHA) functional class I or II. Twelve-hour electrocardiographic recordings were taken in all patients at serial intervals and analyzed for frequency and type of ventricular ectopic beat (VEB). Eighty percent showed VEB's on at least one tape recording. There have been 14 SCD's in a follow-up period ranging between 30 and 54 months, 12 in 87 patients (13.8%) with significant VEB's (frequent, unifocal, multifocal, paired or coupled, and ventricular tachycardia), and only two in 66 patients (3%) with absent or infrequent VEB's (P < 0.02).Although the number of patients in this study is small, the results show that all complex VEB forms together were associated with an excess risk of SCD, notwithstanding the absence of SCD in 27 patients with ventricular parasystole. It is suggested that the differential association with SCD between ventricular extrasystoles and parasystole in the late postinfarction period may have bearing on the mechanism of ventricular fibrillation and SCD.

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