What Is The Prognostic Value of Non-Sustained Ventricular Tachycardia in Patients Without Severely Depressed Ejection Fraction After Myocardial Infarction?

  • G. Turitto
  • N. El-Sherif
Conference paper


Complex Ventricular Ectopy (CVE)/Non-Sustained Ventricular Tachycardia (NS-VT) in the Post-Myocardial Infarction (Ml) Period: Background The predictive accuracy of CVE/NS-VT for serious arrhythmic events/sudden cardiac death (SCD) in the post-MI period has undergone radical evaluation in the last 2 decades. In 1981, Bigger et al reported on 430 patients who sustained acute MI and underwent a 24-hour Holter electrocardiogram (ECG) prior to hospital discharge [1]. Fifty patients (11.6%) had NS-VT, in the form of ≥3 ventricular premature complexes. This group of patients had 38% 1-year mortality rate, compared with a rate of 11.6% in the group without NS-VT. NS-VT had a significant association with many other post-MI risk factors. However, VT was still significantly related to mortality when other variables, including left ventricular ejection fraction (LVEF) were controlled statistically using a multiple logistic regression model. Similar conclusions were later published by Bigger et al. from 820 patients in the Multicenter Post-Infarction Program, of whom 11% had NS-VT recorded on Holter ECG 11±3 days post-MI [2]. NS-VT had a strong and statistically significant association with all-cause and arrhythmic mortality, independent of other risk stratifiers, including depressed LVEF.


Heart Rate Variability Left Ventricular Ejection Fraction Sudden Cardiac Death Preserve Left Ventricular Ejection Fraction Postmyocardial Infarction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bigger JT Jr, Weld FM, Rolnitzky LM (1981) Prevalence, characteristics and significance of ventricular tachycardia (three or more complexes) detected with ambulatory electrocardiographic recording in the late hospital phase of acute myocardial infarction. Am J Cardiol 48:815–823PubMedCrossRefGoogle Scholar
  2. 2.
    Bigger JT, Fleiss JL, Rolnitzky LM, and the Multicenter Post-Infarction Research Group (1986) Prevalence, characteristics and significance of ventricular tachycardia detected by 24-hour continuous electrocardiographic recordings in the late hospital phase of acute myocardial infarction. Am J Cardiol 58:1151–1160PubMedCrossRefGoogle Scholar
  3. 3.
    Hohnloser SH, Gersh BJ (2003) Changing late prognosis of acute myocardial infarction. Impact on management of ventricular arrhythmias in the era of reperfusion and the implantable cardioverter-defibrillator. Circulation 107:941–946PubMedCrossRefGoogle Scholar
  4. 4.
    Klingenheben T, Hohnloser SH (2003) Usefulness of risk stratification for future cardiac events in infarct survivors with severely depressed versus near-normal left ventricular function: results from a prospective long-term follow-up study. Ann Noninv Electrocardiol 8:68–74CrossRefGoogle Scholar
  5. 5.
    Hohnloser SH, Klingenheben T, Zabel M et al (1999) Prevalence, characteristics and prognostic value during long-term follow-up of nonsustained ventricular tachycardia after myocardial infarction in the thrombolytic era. J Am Coll Cardiol 33:1895–1902PubMedCrossRefGoogle Scholar
  6. 6.
    Maggioni AP, Zuanetti G, Franzosi MG et al, on behalf of the GISSI Investigators (1993) Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation 87:312–322PubMedCrossRefGoogle Scholar
  7. 7.
    de Chillou C, Sadoul N, Bizeau O et al (1997) Prognostic value of thrombolysis, coronary artery patency, signal-averaged electrocardiography, left ventricular ejection fraction, and Holter electrocardiographic monitoring for life-threatening ventricular arrhythmias after a first acute myocardial infarction. Am J Cardiol 80:852–858PubMedCrossRefGoogle Scholar
  8. 8.
    Drogemuller A, Seidl K, Schiele R et al (2003) Prognostic value of non-sustained ventricular tachycardias after acute myocardial infarction in the thrombolytic era: importance of combination with ventricular premature beats. Z Kardiol 92:164–172PubMedCrossRefGoogle Scholar
  9. 9.
    Andresen D, Bethge KP, Boissel JP et al (1990) Importance of quantitative analysis of ventricular arrhythmias for predicting the prognosis in low-risk postmyocardial infarction patients. European Infarction Study Group. Eur Heart J11:529–536Google Scholar
  10. 10.
    Moss AJ, Zareba W, Hall J et al (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. New Engl J Med 346:877–883PubMedCrossRefGoogle Scholar
  11. 11.
    Bigger JT (2002) Expanding indications for implantable cardiac defibrillators. New Engl J Med 364:931–933CrossRefGoogle Scholar
  12. 12.
    Friedlander Y, Siscovick DS, Weinmann S et al (1998) Family history as a risk factor for primary cardiac arrest. Circulation 97:155–160PubMedCrossRefGoogle Scholar
  13. 13.
    Jouven X, Desnos M, Guerot C, Ducimetiere P (1999) Predicting sudden death in the population: The Paris Prospective Study I. Circulation 99:1978–1983PubMedCrossRefGoogle Scholar
  14. 14.
    Friedlander Y, Siscovick DS, Arbogast P et al (2002) Sudden cardiac death and myocardial infarction in first degree relatives as predictors of primary cardiac arrest. Atherosclerosis 162:211–216PubMedCrossRefGoogle Scholar
  15. 15.
    Spooner PM, Albert C, Benjamin EL et al (2001) Sudden cardiac death, genes, and arrhythmogenesis: Consideration of new population and mechanistic approaches from a National Heart, Lung, and Blood Institute Workshop, Part II. Circulation 103:2447–2452PubMedCrossRefGoogle Scholar
  16. 16.
    Jouven X, Zureik M, Desnos M et al (2001) Resting heart rate as a predictive risk factor for sudden death in middle aged men. Cardiovasc Res 50:373–378PubMedCrossRefGoogle Scholar
  17. 17.
    Singh JP, Larson MG, O’Donnell CJ et al (1999) Heritability of heart rate variability: The Framingham Heart Study. Circulation 99:2251–2254PubMedCrossRefGoogle Scholar
  18. 18.
    Muller JE (1999) Circadian variation and triggering of acute coronary events. Am Heart J 137(pt 2):51–58Google Scholar
  19. 19.
    Spooner PM, Albert C, Benjamin EL et al (2001) Sudden cardiac death, genes, and arrhythmogenesis: Consideration of new population and mechanistic approaches from a National Heart Lung, and Blood Institute Workshop, Part I. Circulation 103:2361–2364PubMedCrossRefGoogle Scholar
  20. 20.
    Haffner SM (2002) Glucose-intolerance testing in acute myocardial infarction. Lancet 359:2127–2128PubMedCrossRefGoogle Scholar
  21. 21.
    American Diabetes Association: diabetes facts and figures, (2000) Available from
  22. 22.
    Stern MP (1995) Diabetes and cardiovascular disease: “the ”common soil“ hypothesis (review). Diabetes 44:374–396CrossRefGoogle Scholar
  23. 23.
    Balkau B, Jouven X, Ducimetiere P et al (1999) Diabetes as a risk of factor for sudden death. Lancet 354:1968–1969PubMedCrossRefGoogle Scholar
  24. 24.
    Zehender M, Faber T, Koscheck U, Meinertz T, Just H (1995) Ventricular tachyarrhythmias, myocardial ischemia, and sudden cardiac death in patients with hypertensive heart disease. Clin Cardiol 18:377–383PubMedCrossRefGoogle Scholar
  25. 25.
    Bikkina M, Larson MG, Levy D (1993) Asymptomatic left ventricular arrhythmias and mortality risk in subjects with left ventricular hypertrophy. J Am Coll Cardiol 22:1111–1116PubMedCrossRefGoogle Scholar
  26. 26.
    Bradley DJ, Bradley EA, Baughman KL et al (2003) Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA 289:754–756CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • G. Turitto
    • 1
  • N. El-Sherif
    • 1
  1. 1.Cardiac Electrophysiology SectionState University of New York, Downstate Medical CenterBrooklynUSA

Personalised recommendations