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Does Electrophysiologic Study Allow Further Risk Stratification in Survivors of Acute Myocardial Infarction?

  • R. F. E. Pedretti
  • S. Sarzi Braga
Conference paper

Abstract

Several studies are now available about the possible use of electrophysiologic (EP) study in order to identify, among asymptomatic postinfarction patients, those at risk of malignant ventricular arrhythmias. Most papers clearly showed that a positive EP study represents a strong marker of subsequent life-threatening ventricular arrhythmias, supporting a possible role of programmed ventricular stimulation (PVS) in clinical practice to screen high-risk patients. Nevertheless, despite these promising results, EP testing has not been largely used in the past for risk stratification purposes, probably because EP testing is an invasive procedure and because of the lack of efficacy of antiarrhythmic drugs in preventing arrhythmic death. However, data from recent trials on the implantable cardioverter defibrillator (ICD) has refocused attention on the role of PVS in detecting patients at risk of sudden death after acute myocardial infarction (AMI). In the present paper, some of the most important studies on this topic will be reviewed in order to answer the following questions:
  1. 1.

    Among inducible ventricular arrhythmias, which is predictive of subsequent arrhythmic events?

     
  2. 2.

    May EP testing prognosticate independently of noninvasive testing in postinfarction patients?

     
  3. 3.

    May EP testing be used in both early and late postinfarction period to screen for high-risk patients?

     

Keywords

Left Ventricular Ejection Fraction Acute Myocardial Infarction Arrhythmic Event Implantable Cardioverter Defibrillator Implantation Inducible Arrhythmia 
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.

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References

  1. 1.
    Bourke JP, Richards DAB, Ross DL, McGuire MA, Uther JB (1995) Does theinduction of ventricular flutter or fibrillation at electrophysiologic testingafter myocardial infarction have any prognostic significance? Am J Cardiol75:431–435PubMedCrossRefGoogle Scholar
  2. 2.
    BourkeJP, Richards DAB, Ross DL, Wallace EM, McGuire MA, Uther JB (1991) Routineprogrammed electrical stimulation in survivors of acute myocardial infarctionfor prediction of spontaneous ventricular tachyarrhythmias during follow-up:results, optimal stimulation protocol and cost-effective screening. J Am CollCardiol 18:780–788CrossRefGoogle Scholar
  3. 3.
    Denniss AR, Richards DA, Cody DV, Russell PA, Young AA, Cooper MJ, Ross DL, Uther JB (1986)Prognostic significance of ventricular tachycardia and fibrillation induced atprogrammed stimulation and delayed potentials detected on the signalaveragedelectrocardiograms of survivors of acute myocardial infarction. Circulation74:731–745PubMedCrossRefGoogle Scholar
  4. 4.
    RichardsDAB, Byth K, Ross DL, Uther JB (1991) What is the best predictor of spontaneousventricular tachycardia and sudden death after myocardial infarction.Circulation 83:756–763PubMedCrossRefGoogle Scholar
  5. 5.
    PedrettiR, Etro MD, Laporta A, Sarzi Braga S, Carù B (1993) Prediction of latearrhythmic events after acute myocardial infarction from combined use ofnoninvasive prognostic variables and inducibility of sustained monomorphicventricular tachycardia. Am J Cardiol 71:1131–1141PubMedCrossRefGoogle Scholar
  6. 6.
    Zoni-BerissoM, Molini D, Mela GS, Vecchio C (1996) Value of programmed ventricularstimulation in predicting sudden death and sustained ventricular tachycardia insurvivors of acute myocardial infarction. Am J Cardiol 77:673–680PubMedCrossRefGoogle Scholar
  7. 7.
    AndresenD, Steinbeck G, BrüggemanT, Müller D, Haberl R, Steffen B, Hoffman E,Wegscheider K, Dissman R, Ehlers HC (1999) Risk stratification followingmyocardial infarction in the thrombolytic era: a two-step strategy usingnoninvasive and invasive methods. J Am Coll Cardiol 33:131–138PubMedCrossRefGoogle Scholar
  8. 8.
    SchmittC,Schneider MAE, Zrenner B, Weyerbrock S, Plewan A, Barthel P, Schmidt G (1997)Risk stratification after acute myocardial infarction: the role of programmedventricular stimulation. Circulation 96:1–716 (abstr)Google Scholar
  9. 9.
    WilberDJ,OlshanskyB, Moran JF, ScanionPJ(1990) Electrophysiological testing and nonsustained ventricular tachycardia.Use and limitations in patients with coronary artery disease and impairedventricular function. Circulation 82:350–358PubMedCrossRefGoogle Scholar
  10. 10.
    MossAJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S,Waldo AL, Wilber D, Brown MW, Heo M (1996) Improved survival with animplanted defibrillator in patients with coronary disease at high risk forventricular arrhythmia. N Engl J Med 335:1933–1940PubMedCrossRefGoogle Scholar
  11. 11.
    Raviele A, Bongiorni MG, Brignole M, Cappato R, CapucciA, Gaita F, Mangiameli S, MonteneroA, Pedretti R, Salerno J, Sermasi S (1999) Which strategy is “best”after myocardial infarction? The beta-blocker strategy plus implantablecardioverter defibrillator trial: rationale and study design. Am J Cardiol83:104D–111DPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • R. F. E. Pedretti
    • 1
  • S. Sarzi Braga
    • 1
  1. 1.Divisione di Cardiologia, Clinica del Lavoro e della RiabilitazioneIRCCS Fondazione Salvatore MaugeriTradate (VA)Italy

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