Risk Stratification for Serious Arrhythmic Events in Post-Infarction Patients

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


In spite of recent improvement in overall cardiovascular mortality, posthospital mortality remains high in survivors of acute myocardial infarction (AMI). Approximately one third of late deaths in survivors of AMI are sudden and unexpected, and the risk of sudden death persists for years after the AMI [1, 2]. Prevention of sudden cardiac death (SCD), which in the majority of cases is due to malignant ventricular tachyarrhythmias (VT, defined as hypotensive ventricular tachycardia/ventricular fibrillation), remains a formidable clinical challenge in survivors of AMI. Management strategy of this major health care problem has centered over the years on two closely related aspects: (1) how to identify those at risk of SCD, and (2) what the best management modalities are — pharmacotherapy or the implantable cardioverter-defibrillator (ICD). Following recent publications of the results of several multicenter studies, pharmacotherapy — mainly antiarrhythmic drugs — has not proven so far to be an effective management modality for those at risk of SCD. This cleared the way for more widespread use of the ICD as the sole or main management modality. Primarily because of the high cost of the ICD, and the invasive nature of this therapeutic modality, the prophylactic use of the device for primary prevention of SCD did not gain momentum until recently. This aspect of management strategy for SCD is still in the clinical research domain, with several primary ICD prevention trials currently underway. However, this trend has highlighted the urgent need for more powerful risk stratification algorithms for SCD in this population.


Heart Rate Variability Acute Myocardial Infarction Arrhythmic Event Arrhythmic Death Complex Ventricular Arrhythmia 
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Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • N. El-Sherif
    • 1
    • 2
  • G. Turitto
    • 1
    • 2
  1. 1.Cardiology Division, Department of MedicineState University of New YorkBrooklynUSA
  2. 2.Health Science Center and Veterans Affairs Medical CenterBrooklynUSA

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