Electrophysiologic Testing to Identify High-Risk Patients After Acute Myocardial Infarction

  • Eric N. Prystowsky


Many patients who survive the acute phase of a myocardial infarction are at risk of sudden cardiac death after hospital discharge, often in the first six months after leaving the hospital. Some factors that indicate high frequency of sudden death include substantial ventricular myocardial dysfunction [1] and the occurrence of “complex” premature ventricular depolarizations and nonsustained ventricular tachycardia [2–4]. However, the predictive value of these factors alone for sudden death is not sufficiently accurate for clinical usefulness. In patients who have coronary artery disease but no recent myocardial infarction, electrophysiologic stimulation has a high degree of sensitivity [5] for inducing the patient’s clinical arrhythmia, and serial electrophysiologic testing has proven useful for determining the drug therapy that will prevent recurrent arrhythmias [5–8]. Recently, electrophysiologic testing to initiate ventricular tachycardia has been advocated as a technique to identify patients in the postmyocardial infarction period most likely to have sudden cardiac death [9, 10].


Acute Myocardial Infarction Sudden Death Ventricular Tachycardia Electrophysiologic Testing Sustained Ventricular Tachycardia 
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  1. 1.
    Schulze RA, Strauss HW, Pitt B: Sudden death in the year following myocardial infarction: relation to ventricular premature contractions in the late hospital phase and left ventricular ejection fraction. Am J Med 62: 192, 1977.PubMedCrossRefGoogle Scholar
  2. 2.
    Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Shapiro S: Ventricular premature beats and mortality after myocardial infarction. N Engl J Med 297: 750, 1977.PubMedCrossRefGoogle Scholar
  3. 3.
    Moss AJ, Davis HT, De Camilla J, Bayer LW: Ventricular ectopic beats and their relation to sudden and nonsudden cardiac death after myocardial infarction. Circulation 60: 998, 1979.PubMedGoogle Scholar
  4. 4.
    Bigger JT, Weld FM: Analysis of prognostic significance of ventricular arrhythmias after myocardial infarction: shortcomings of Lown grading system. Br Heart J 45: 717, 1981.PubMedCrossRefGoogle Scholar
  5. 5.
    Naccarelli GV, Prystowsky EN, Jackman WM, Heger JJ, Rahilly GT, Zipes DP: Role of electrophysiologic testing in managing patients who have ventricular tachycardia unrelated to coronary artery disease. Am J Cardiol 50: l65, 1982.Google Scholar
  6. 6.
    Mason JW, Winkle RA: Electrode—catheter arrhythmia induction in the selection and assessment of antiarrhythmic drug therapy for recurrent ventricular tachycardia. Circulation 58: 971, 1978.PubMedGoogle Scholar
  7. 7.
    Horowitz LN, Josephson ME, Farshidi A, Spielman SR, Michelson EL, Greenspan AM: Recurrent sustained ventricular tachycardia. 3- Role of the electrophysiologic study in selection of antiarrhythmic regimens. Circulation 58: 986, 1978.PubMedGoogle Scholar
  8. 8.
    Fisher JD, Cohen HL, Mehra R, Altschuler H, Escher DJW, Furman S: Cardiac pacing and pacemakers. II. Serial electrophysiologic-pharmacologic testing for control of recurrent tachyarrhythmias. Am Heart J 93: 658, 1977.PubMedCrossRefGoogle Scholar
  9. 9.
    Hamer A, Vohra J, Hunt D, Sloman G: Prediction of sudden death by electrophysiologic studies in high risk patients surviving acute myocardial infarction. Am J Cardiol 50: 223, 1982.PubMedCrossRefGoogle Scholar
  10. 10.
    Richards DA, Cody DV, Denniss AR, Russell PA, Young AA, Uther JB: Ventricular electrical instability: a predictor of death after myocardial infarction. Am J Cardiol 51: 75, 1983.PubMedCrossRefGoogle Scholar
  11. 11.
    Greene HL, Reid PR, Schaeffer AH: The repetitive ventricular response in man: a predictor of sudden death. N Engl J Med 299: 729, 1978.PubMedCrossRefGoogle Scholar
  12. 12.
    Naccarelli GV, Prystowsky EN, Jackman WM, Heger JJ, Rinkenberger RL, Zipes DP: The repetitive ventricular response: prevalence and prognostic significance. Br Heart J 46: 152, 1981.PubMedCrossRefGoogle Scholar
  13. 13.
    Ruskin JN, Garan H: Repetitive ventricular responses in patients with life-threatening ventricular arrhythmias. Am J Cardiol 45: 406, 1980.CrossRefGoogle Scholar
  14. 14.
    Mason JW: Repetitive beating after single ventricular extrastimuli: incidence and prognostic significance in patients with recurrent ventricular tachycardia. Am J Cardiol 45: 1126, 1980.PubMedCrossRefGoogle Scholar
  15. 15.
    Marchlinski EE, Waxman HL, Buxton AE, Josephson ME: Predictive value of programmed stimulation in determining electrical instability after myocardial infarction. J Am Coll Cardiol 1: 585, 1983.Google Scholar
  16. 16.
    Prystowsky EN, Naccarelli GV, Rahilly GT, Heger JJ, Zipes DP: Electrophysiologic and anatomic characteristics associated with ventricular tachycardia induced at the right ventricular outflow tract but not at the apex. Am J Cardiol 49: 959, 1982.CrossRefGoogle Scholar
  17. 17.
    Denniss AR, Cody DV, Fenton SM, Richards DA, Ross DL, Russell PA, Young AA, Uther JB: Significance of delayed activation potentials in survivors of myocardial infarction. J Am Coll Cardiol 1: 582, 1983.Google Scholar
  18. 18.
    Breithardt G, Borggrefe M, Quantius B, Karbenn U, Seipel L: Ventricular vulnerability assessed by programmed ventricular stimulation in patients with and without late potentials. Circulation 68: 275, 1983.PubMedCrossRefGoogle Scholar
  19. 19.
    Lie KI, Liem KL, Schuilenburg RM, David GK, Durrer D: Early identification of patients developing late in-hospital ventricular fibrillation after discharge from the coronary care unit: a 5 1/2 year retrospective and prospective study of 1,897 patients. Am J Cardiol 41: 674, 1978.PubMedCrossRefGoogle Scholar

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© Martinus Nijhoff Publishing, Boston/Dordrecht/Lancaster 1985

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  • Eric N. Prystowsky

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