Identification of patients with ventricular tachycardia after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring, and cardiac catheterization.

Electrocardiographic signal averaging techniques have demonstrated a low-amplitude late potential and a long filtered QRS complex in patients with ventricular tachycardia (VT) after myocardial infarction. Complex ventricular ectopy and left ventricular aneurysms have also been associated with VT. The purposes of this study were (1) to determine whether the findings from the signal-averaged electrocardiogram (ECG) were independent of those from Holter monitoring and cardiac catheterization and (2) to determine the combination of findings from the signal-averaged ECG, cardiac catheterization, and Holter monitoring that best characterize patients with VT after myocardial infarction. We studied 174 patients after myocardial infarction, 98 of whom had recurrent sustained VT. By multivariate logistic regression only three parameters were found to be independently significant, listed in order of power: positive signal-averaged ECG (presence of a late potential or a long filtered QRS duration), peak premature ventricular contraction greater than 100/hr, and presence of a left ventricular aneurysm (p less than .001). The signal-averaged ECG provides independent information in identifying patients with VT after myocardial infarction.

[1]  R Lazzara,et al.  Re‐entrant Ventricular Arrhythmias in the Late Myocardial Infarction Period: 2. Patterns of Initiation and Termination of Re‐entry , 1977, Circulation.

[2]  D. Mortara,et al.  Body Surface Detection of Delayed Depolarizations in Patients with Recurrent Ventricular Tachycardia and Left Ventricular Aneurysm , 1981, Circulation.

[3]  M. Raphael,et al.  Clinical diagnosis and prognosis of ventricular aneurysm. , 1968, British heart journal.

[4]  L Seipel,et al.  Non-invasive detection of late potentials in man--a new marker for ventricular tachycardia. , 1981, European heart journal.

[5]  W. Weaver,et al.  Angiographic Findings and Prognostic Indicators in Patients Resuscitated from Sudden Cardiac Death , 1976 .

[6]  E. Nagel,et al.  Prehospital ventricular defibrillation. Prognosis and follow-up course. , 1974, The New England journal of medicine.

[7]  M. Josephson,et al.  Changes in ventricular refractoriness after an extrastimulus: effects of prematurity, cycle length and procainamide. , 1983, The American journal of cardiology.

[8]  H. Burchell,et al.  Postinfarction ventricular aneurysm. A clinicomorphologic and electrocardiographic study of 80 cases. , 1965, American heart journal.

[9]  B. Pitt,et al.  Left Ventricular and Coronary Angiographic Anatomy: Relationship to Ventricular Irritability in the Late Hospital Phase of Acute Myocardial Infarction , 1977, Circulation.

[10]  F. Harrell,et al.  Survival in medically treated coronary artery disease. , 1979, Circulation.

[11]  J. Uther,et al.  Ventricular electrical instability: a predictor of death after myocardial infarction. , 1983, The American journal of cardiology.

[12]  V Hombach,et al.  The applicability of the signal averaging technique in clinical cardiology , 1982, Clinical cardiology.

[13]  H. Greene,et al.  The repetitive ventricular response in man. A predictor of sudden death. , 1978, The New England journal of medicine.

[14]  L. Horowitz,et al.  Electrophysiologic and hemodynamic studies in patients resuscitated from cardiac arrest. , 1980, The American journal of cardiology.

[15]  G. Breithardt,et al.  Prevalence of late potentials in patients with and without ventricular tachycardia: correlation with angiographic findings. , 1982, The American journal of cardiology.

[16]  G. Moe,et al.  Cumulative effects of cycle length on refractory periods of cardiac tissues. , 1969, The American journal of physiology.

[17]  M. Kotler,et al.  Prognostic Significance of Ventricular Ectopic Beats with Respect to Sudden Death in the Late Postinfarction Period , 1973, Circulation.

[18]  B. Pitt,et al.  Sudden death in the year following myocardial infarction. Relation to ventricular premature contractions in the late hospitals phase and left ventricular ejection fraction. , 1977, The American journal of medicine.

[19]  R Lazzara,et al.  Re‐entrant Ventricular Arrhythmias in the Late Myocardial Infarction Period: 1. Conduction Characteristics in the Infarction Zone , 1977, Circulation.

[20]  L. Horowitz,et al.  Electrocardiographic Findings in Patients with Obstructive and Nonobstructive Hypertrophic Cardiomyopathy , 1978, Circulation.

[21]  J. Fleiss,et al.  Risk stratification and survival after myocardial infarction. , 1983, The New England journal of medicine.

[22]  J. Spear,et al.  Detection of delayed ventricular activation on the body surface in dogs. , 1981, The American journal of physiology.

[23]  L. Horowitz,et al.  Repetitive responses to ventricular extrastimuli: incidence, mechanism, and significance. , 1980, American heart journal.

[24]  J. Ruskin,et al.  Out-of-hospital cardiac arrest: electrophysiologic observations and selection of long-term antiarrhythmic therapy. , 1980, The New England journal of medicine.

[25]  A H Harken,et al.  Relation between late potentials on the body surface and directly recorded fragmented electrograms in patients with ventricular tachycardia. , 1983, The American journal of cardiology.

[26]  P. Denes,et al.  Quantitative Analsis of the High‐frequency Components of the Terminal Portion of the Body Surface QRS in Normal Subjects and in Patients with Ventricular Tachycardia , 1983, Circulation.

[27]  J. Ruskin,et al.  Repetitive Responses to Single Ventricular Extrastimuli in Patients with Serious Ventricular Arrhythmias: Incidence and Clinical Significance , 1981, Circulation.

[28]  M. Cohen,et al.  Determinants of ventricular tachycardia in patients with coronary artery disease and ventricular aneurysm. Clinical, hemodynamic, and angiographic factors. , 1983, American Journal of Cardiology.

[29]  P. Greenland,et al.  Selection and interpretation of diagnostic tests and procedures. Principles and applications. , 1981, Annals of internal medicine.

[30]  M. Simson.  Use of Signals in the Terminal QRS Complex to Identify Patients with Ventricular Tachycardia After Myocardial Infarction , 1981, Circulation.

[31]  H. Blackburn.  Prognostic importance of premature beats following myocardial infarction. Experience in the coronary drug project. , 1973, JAMA.

[32]  B. Efron.  Computers and the Theory of Statistics: Thinking the Unthinkable , 1979 .

[33]  R Lazzara,et al.  Recording from the body surface of arrhythmogenic ventricular activity during the S-T segment. , 1978, The American journal of cardiology.

[34]  Anderson Hj,et al.  Recurrent Sustained Ventricular Tachycardia 1.Mechanisms , 1977 .

[35]  D. Oakes,et al.  Statistical Methods for Comparative Studies , 1980 .