Evaluation of the Severity of Ventricular Rhythm Disturbances: Value of Electrophysiological Testing and Recording of Late Potentials
Sudden death is one of the major risks in patients suffering from coronary heart disease especially after myocardial infarction. In most instances this final event is caused by ventricular tachyarrhythmias. Many studies have shown that ventricular premature beats are the harbingers of sudden death in these patients . The prerequisite for the induction of ventricular tachyarrhythmias is the arrhythmogenic electrophysiological substrate. The presence of an arrhythmogenic substrate is, however, not sufficient to develop ventricular tachycardia. Instead, some additional factors (such as ventricular premature beats) are necessary to initiate a reentrant tachycardia. Ventricular premature beats can be recorded by Holter monitoring and exercise tests. However, they have been shown to have a low predictive value for sudden death [2, 3]. The presence or absence of an arrhythmogenic substrate can be assessed by means of programmed stimulation (ventricular “vulnerability”). Of course, the fibrillation threshold cannot be measured in man. However, in experimental studies a good correlation between the fibrillation threshold and repetitive ventricular responses was found .
KeywordsAcute Myocardial Infarction Ventricular Tachycardia Ventricular Tachyarrhythmia Late Potential Sustained Ventricular Tachycardia
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- 4.Matta RJ, Yerrier R, Lown B (1976) The repetitive extrasystole as an index of vulnerability to ventricular fibrillation. Am J Physiol 230: 1461Google Scholar
- 5.Abendroth RR, Breithardt G, Biese HP, Yeh HL, Seipel L (1981) Häufigkeit, Reproduzierbarkeit und prognostische Bedeutung ventrikulärer Echoschläge bei Patienten mit und ohne koronare Herzkrankheit. Z Kardiol 70: 889–894Google Scholar
- 7.Breithardt G, Becker R, Seipel L, Abendroth RR, Ostermeyer J (1981) Non-invasive detection of late potentials in man - a new marker for ventricular tachycardia. Eur Heart J 2:1 –11Google Scholar
- 8.Breithardt G, Borggrefe M, Haerten K, Seipel L (1986) Value of electrophysiologic testing, recording of late potentials by averaging techniques and Holter monitoring for the identification of high risk patients after acute myocardial infarction. In: Kulbertus HE (ed) Medical management of cardiac arrhythmias. Churchill Livingstone, Edinburgh, p 228–245Google Scholar
- 11.Breithardt G, Schwarzmaier J, Borggrefe M, Haerten K, Seipel L (1983) Prognostic significance of late ventricular potentials after acute myocardial infarction. Eur Heart J 4:487– 495Google Scholar
- 13.Denniss AR, Richards DA, Cody DV, Russell PA, Young AA, Ross DL, Uther JB (1987) Correlation between signal-averaged electrocardiogram and programmed stimulation in patients with and without spontaneous ventricular tachyarrhythmias. Am J Cardiol 59:586– 590Google Scholar
- 14.von Leiter ER, Oeff M, Loock D, Jahns B, Schröder R (1983) Value of non-invasively detected delayed ventricular depolarization to predict prognosis in post myocardial infarction patients (abstr). Circulation 68 [Suppl III]: 831Google Scholar
- 18.Gomes JA, Winters SL, Stewart D, Horowitz S, Milner M, Barreca P (1987) A new non-invasive index to predict sustained ventricular tachycardia and sudden death in the first year after myocardial infarction: based on signal-averaged electrocardiogram, radionuclide ejection fraction and Holter monitoring. J Am Coll Cardiol 10: 349–357PubMedCrossRefGoogle Scholar
- 19.Kuchar DL, Thorburn CW, Sammel NL (1987) Prediction of serious arrhythmic events after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring and radionuclide ventriculography. J Am Coll Cardiol 9: 531–538Google Scholar
- 21.Buxton AE, Simson MB, Falcone RA, Marchlinski FE, Doherty JU, Josephson ME (1987) Results of signal-averaged electrocardiography and electrophysiologic study in patients with non-sustained ventricular tachycardia after healing of acute myocardial infarction. Am J Cardiol 60: 80–85PubMedCrossRefGoogle Scholar
- 27.Marchlinski FE, Buxton AE, Waxman HL, Josephson ME (1983) Identifying patients at risk of sudden death after myocardial infarction. Value of the response to programmed stimulation, degree of ventricular ectopic activity and severity of left ventricular dysfunction. Am J Cardiol 52: 1190–1196Google Scholar
- 31.Denniss RA, Richards DA, Cody DV, Russel PA, Young A A, Cooper MJ, Ross DL, Uther JB (1986) Prognostic significance of ventricular tachycardia and fibrillation induced at programmed stimulation and delayed potentials detected on the signal-averaged electrocardiograms of survivors of acute myocardial infarction. Circulation 74: 731–745PubMedCrossRefGoogle Scholar