Abstract
The most frequent reasons for syncope in patients after myocardial infarction are complex ventricular arrhythmias (CVA)1–4. Ventricular arrhythmias (VA) are present in approximately 20–50% of patients after myocardial infarction5. On the other hand 90% of sudden cardiac death episodes are caused by VA6. Most patients present with VA in standard 12-lead ECG or in 24-h ECG Holter monitoring. However, in some patients after myocardial infarction, detection of VA is impossible, in spite of repetitive 24-h ECG recordings. In these patients we may observe only symptoms related to VA, such as syncope, presyncope or vertigo. These patients are thus especially in danger of sudden cardiac death because of the impossibility of arrhythmia mechanism assessment; 24-h ECG Holter monitoring is not a sufficient diagnostic tool in such cases. Improvement of suitable diagnostic procedures, for instance programmed electrical stimulation (PES), in this group of patients after myocardial infarction, is very important both for defining the very high sudden cardiac death risk patients and for sufficient anti-arrhythmic treatment7,8.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Rosenthal ME, Oseran DS, Gang E, Peter T. Sudden cardiac death following myocardial infarction. Am Heart J 1985; 109: 865–72.
Naccarelli GV. Cardiac Arrhythmias: a practical approach. Mount Kisco, NY: Futura; 1991.
Brugada P, Andries E. The rationale for prophylactic implantation of a defibrillation in “high risk” patients. PACE 1993; 16: 547–51.
Camm AJ, Fei Lu. Risk stratification after myocardial infarction. PACE 1994; 17: 401–16.
Satarelli P, Bellocci F, Loperfido F et al. Ventricular arrhythmia induced by programmed stimulation after acute myocardial infarction. Am J Cardiol 1985; 55: 391–402.
Hinkle LE, Thaler HT. Clinical classificattion of cardiac deaths. Circulation 1982; 65: 457–64.
Hamer A, Vohra J, Hund D, Slowmai G. Prediction of sudden death by electrophysiologic studies in high risk patients surviving acute myocardial infarction. Am J Cardiol 1982; 50: 223–30.
Richards DA, Cody DV, Dennis AR, Russell PA, Young AA, Uther JB. Ventricular electrical instability: a predictor of death after myocardial infarction. Am J Cardiol 1983; 51: 75–84.
Breithardt G, Cain ME, El-Sherif N et al. Standards for analysis of ventricular late potentials using high-resolution electrocardiography. Eur-Heart-J 1991; 12; 473–80.
Nogami A, Aonuma K, Takahashi A et al. Usefuness of early versus late programmed ventricular stimulation in acute myocardial infarction. Am J Cardiol. 1991; 68: 13–20.
Denniss AR, Cody DV, Ho B et al. Prognostic significance of inducible ventricular tachycardia after myocardial infarction. J Am Coll Cardiol 1984; 3: 610–18.
Krol R, Morady F, Fiaker G et al. Electrophysiologic testing in patients with unexplained syncope: clinical and noninvasive predictors of outcome. J Am Coll Cardiol 1987; 10: 358–63.
Shenasa M, Borggrefe M, Haverkamp W et al. Ventricular tachycardia. Lancet 1993; 341: 1512–19.
Ricks WB, Winkle RA, Shumway NE et al. Surgical management of life-threatening ventricular arrhythmias in patients with coronary artery disease. Circulation 1977; 56: 38–46.
Buda AJ, Stinson EB, Harrison DC. Surgery for life-threatening ventricular tachyarrhythmias. Am J Cardiol 1979; 44: 1171–79.
Lampert S, Lown B, Graboys T. Determinants of survival in patients with malignant ventricular arrhythmias associated with coronary artery disease. Am J Cardiol 1988; 61: 791–7.
Zoni-Berisso M, Molini D, Mela GS, Vecchio C. Value of programmed ventricular stimulation in predicting sudden death and sustained ventricular tachycardia in survivors of acute myocardial infarction. Am J Cardiol 1996; 77: 673–80.
Gomes JA, Winters SL, Stewart D, Horowitz S, Milner M, Barreca P. A new noninvasive 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 1987; 10: 349–57.
Viskin S, Bethassen B. Should electrophysiological studies be performed in asymptomatic patients following myocardial infarction? PACE 1994; 17: 1082–89.
Mason JW, Marcus FI, Bigger JT et al. A summary and assessment of the findings and conclusions of the ESVEM trial. Prog Cardiovasc Dis 1996; 38: 347–58.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1998 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Piwowarska, W., Mroczek-Czernecka, D., Pietrucha, A., Węgrzynowska, M., Stobierska-Dzierżek, B. (1998). The Value of Electrophysiological Testing in Diagnosis of Syncope in Post-infarction Patients, without Complex Ventricular Arrhythmias Detected in 24-hour ECG. In: Vardas, P.E. (eds) Cardiac Arrhythmias, Pacing & Electrophysiology. Developments in Cardiovascular Medicine, vol 201. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5254-9_15
Download citation
DOI: https://doi.org/10.1007/978-94-011-5254-9_15
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-010-6210-7
Online ISBN: 978-94-011-5254-9
eBook Packages: Springer Book Archive