Prediction of sudden death and spontaneous ventricular tachycardia in survivors of complicated myocardial infarction: Value of the response to programmed stimulation using a maximum of three ventricular extrastimuli
The prognostic significance of ventricular arrhythmias induced by programmed electrical stimulation was evaluated in 50 survivors of acute myocardial infarction complicated by a major new conduction disturbance (38 patients), congestive heart failure (33 patients) or sustained ventricular tachyarrhy...
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Veröffentlicht in: | Journal of the American College of Cardiology 1985-06, Vol.5 (6), p.1292-1301 |
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description | The prognostic significance of ventricular arrhythmias induced by programmed electrical stimulation was evaluated in 50 survivors of acute myocardial infarction complicated by a major new conduction disturbance (38 patients), congestive heart failure (33 patients) or sustained ventricular tachyarrhythmias (22 patients), alone or in combination. Programmed stimulation was performed in patients in stable condition 7 to 36 days (mean 16) after infarction using one to three extrastimuli at four times diastolic threshold at a maximum of two right ventricular sites. Two groups were identified by the response to programmed stimulation: 17 patients with sustained (>15 seconds) or nonsustained (>7 beats but ≤15 seconds) ventricular tachycardia (group I), and 33 patients with 0 to 7 intraventricular reentrant complexes in response to maximal stimulation efforts (group II). Group I patients had a higher incidence of anterior infarction than that of patients in group II (71 versus 42%), had lower left ventricular ejection fraction (mean 0.35 versus 0.48) and were more often treated with antiarrhythmic drugs (47 versus 18%, p < 0.05). There were no significant differences between groups in the occurrence of congestive failure, new conduction disorders or sustained ventricular arrhythmias with infarction, or in the proportions treated with a beta-receptor blocking agent, coronary bypass grafting or a permanent pacemaker.
Total cardiac mortality was 24% during a mean follow-up period of 23 months and did not differ between groups; however, the response to programmed stimulation identified a group at high risk of late sudden death or spontaneous ventricular tachycardia: 7 (41%) of 17 group I patients compared with 0 of 33 group II patients (p < 0.001). The induction of sustained or nonsustained ventricular tachycardia identified all patients who died suddenly or had spontaneous tachycardia (sensitivity 100%), but triple extrastimuli were required to induce prognostically significant arrhythmias in five of these seven patients; the specificity of this protocol was only 57%. When the clinical variables of the group were evaluated individually, the response to programmed stimulation had a stronger association with occurrence of late sudden death than did any other factor (Fisher's exact test, p < 0.001); however, a type II error could not be excluded.
Thus, programmed ventricular stimulation using a maximum of three extrastimuli may be a sensitive but relatively nonspecific |
doi_str_mv | 10.1016/S0735-1097(85)80339-9 |
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Total cardiac mortality was 24% during a mean follow-up period of 23 months and did not differ between groups; however, the response to programmed stimulation identified a group at high risk of late sudden death or spontaneous ventricular tachycardia: 7 (41%) of 17 group I patients compared with 0 of 33 group II patients (p < 0.001). The induction of sustained or nonsustained ventricular tachycardia identified all patients who died suddenly or had spontaneous tachycardia (sensitivity 100%), but triple extrastimuli were required to induce prognostically significant arrhythmias in five of these seven patients; the specificity of this protocol was only 57%. When the clinical variables of the group were evaluated individually, the response to programmed stimulation had a stronger association with occurrence of late sudden death than did any other factor (Fisher's exact test, p < 0.001); however, a type II error could not be excluded.
Thus, programmed ventricular stimulation using a maximum of three extrastimuli may be a sensitive but relatively nonspecific method for identifying survivors of complicated infarction at high risk of late sudden death or spontaneous ventricular arrhythmias.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(85)80339-9</identifier><identifier>PMID: 2582016</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cardiac Complexes, Premature - etiology ; Cardiac Complexes, Premature - physiopathology ; Cardiology. Vascular system ; Coronary heart disease ; Death, Sudden - etiology ; Electric Stimulation ; Electrocardiography ; Female ; Follow-Up Studies ; Heart ; Heart - physiopathology ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Risk ; Tachycardia - etiology</subject><ispartof>Journal of the American College of Cardiology, 1985-06, Vol.5 (6), p.1292-1301</ispartof><rights>1985 American College of Cardiology Foundation</rights><rights>1985 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c338t-754ce7e6d87a7c4c803ebdacbe527c253b94d5d4fdaea5d2bc3a2b0496d0491e3</citedby><cites>FETCH-LOGICAL-c338t-754ce7e6d87a7c4c803ebdacbe527c253b94d5d4fdaea5d2bc3a2b0496d0491e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109785803399$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=9225735$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/2582016$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Waspe, Lawrence E.</creatorcontrib><creatorcontrib>Seinfeld, David</creatorcontrib><creatorcontrib>Ferrick, Aileen</creatorcontrib><creatorcontrib>Kim, Soo G.</creatorcontrib><creatorcontrib>Matos, Jeffrey A.</creatorcontrib><creatorcontrib>Fisher, John D.</creatorcontrib><title>Prediction of sudden death and spontaneous ventricular tachycardia in survivors of complicated myocardial infarction: Value of the response to programmed stimulation using a maximum of three ventricular extrastimuli</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>The prognostic significance of ventricular arrhythmias induced by programmed electrical stimulation was evaluated in 50 survivors of acute myocardial infarction complicated by a major new conduction disturbance (38 patients), congestive heart failure (33 patients) or sustained ventricular tachyarrhythmias (22 patients), alone or in combination. Programmed stimulation was performed in patients in stable condition 7 to 36 days (mean 16) after infarction using one to three extrastimuli at four times diastolic threshold at a maximum of two right ventricular sites. Two groups were identified by the response to programmed stimulation: 17 patients with sustained (>15 seconds) or nonsustained (>7 beats but ≤15 seconds) ventricular tachycardia (group I), and 33 patients with 0 to 7 intraventricular reentrant complexes in response to maximal stimulation efforts (group II). Group I patients had a higher incidence of anterior infarction than that of patients in group II (71 versus 42%), had lower left ventricular ejection fraction (mean 0.35 versus 0.48) and were more often treated with antiarrhythmic drugs (47 versus 18%, p < 0.05). There were no significant differences between groups in the occurrence of congestive failure, new conduction disorders or sustained ventricular arrhythmias with infarction, or in the proportions treated with a beta-receptor blocking agent, coronary bypass grafting or a permanent pacemaker.
Total cardiac mortality was 24% during a mean follow-up period of 23 months and did not differ between groups; however, the response to programmed stimulation identified a group at high risk of late sudden death or spontaneous ventricular tachycardia: 7 (41%) of 17 group I patients compared with 0 of 33 group II patients (p < 0.001). The induction of sustained or nonsustained ventricular tachycardia identified all patients who died suddenly or had spontaneous tachycardia (sensitivity 100%), but triple extrastimuli were required to induce prognostically significant arrhythmias in five of these seven patients; the specificity of this protocol was only 57%. When the clinical variables of the group were evaluated individually, the response to programmed stimulation had a stronger association with occurrence of late sudden death than did any other factor (Fisher's exact test, p < 0.001); however, a type II error could not be excluded.
Thus, programmed ventricular stimulation using a maximum of three extrastimuli may be a sensitive but relatively nonspecific method for identifying survivors of complicated infarction at high risk of late sudden death or spontaneous ventricular arrhythmias.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiac Complexes, Premature - etiology</subject><subject>Cardiac Complexes, Premature - physiopathology</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Death, Sudden - etiology</subject><subject>Electric Stimulation</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Risk</subject><subject>Tachycardia - etiology</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1985</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV-L1DAUxYMo67j6ERbyIKIP1SRtmtaXRRb_wYKCf17DbXK7E2mbMUmHnU_q1zGdDgM--ZJA8jvnXO4h5Iqz15zx-s03pkpZcNaql4181bCybIv2AdlwKZuilK16SDZn5DF5EuMvxljd8PaCXAjZiGyyIX--BrTOJOcn6nsaZ2txohYhbSlMlsadnxJM6OdI9zil4Mw8QKAJzPZgIFgH1E1ZF_Zu70NcTIwfd4MzkNDS8eBXashYD-GY9Jb-hGHGhU1bpAGXlIg0eboL_i7AOGZpTG7MWcfR5uimOwp0hPv8OK7KgPjPTHifAqwq95Q86mGI-Ox0X5IfH95_v_lU3H75-Pnm3W1hyrJJhZKVQYW1bRQoU5m8RuwsmA6lUEbIsmsrK23VW0CQVnSmBNGxqq1tPjiWl-TF6psH_z1jTHp00eAwrDvTquZCKMUzKFfQBB9jwF7vghshHDRneilUHwvVS1u6kfpYqG6z7uoUMHd5K2fVqcH8__z0D9HA0AeYjItnrBVCZtuMXa8Y5mXsHQYdjcPJ5PIDmqStd_8Z5C_FkcWm</recordid><startdate>198506</startdate><enddate>198506</enddate><creator>Waspe, Lawrence E.</creator><creator>Seinfeld, David</creator><creator>Ferrick, Aileen</creator><creator>Kim, Soo G.</creator><creator>Matos, Jeffrey A.</creator><creator>Fisher, John D.</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>198506</creationdate><title>Prediction of sudden death and spontaneous ventricular tachycardia in survivors of complicated myocardial infarction: Value of the response to programmed stimulation using a maximum of three ventricular extrastimuli</title><author>Waspe, Lawrence E. ; Seinfeld, David ; Ferrick, Aileen ; Kim, Soo G. ; Matos, Jeffrey A. ; Fisher, John D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c338t-754ce7e6d87a7c4c803ebdacbe527c253b94d5d4fdaea5d2bc3a2b0496d0491e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1985</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiac Complexes, Premature - etiology</topic><topic>Cardiac Complexes, Premature - physiopathology</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Death, Sudden - etiology</topic><topic>Electric Stimulation</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Risk</topic><topic>Tachycardia - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Waspe, Lawrence E.</creatorcontrib><creatorcontrib>Seinfeld, David</creatorcontrib><creatorcontrib>Ferrick, Aileen</creatorcontrib><creatorcontrib>Kim, Soo G.</creatorcontrib><creatorcontrib>Matos, Jeffrey A.</creatorcontrib><creatorcontrib>Fisher, John D.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Waspe, Lawrence E.</au><au>Seinfeld, David</au><au>Ferrick, Aileen</au><au>Kim, Soo G.</au><au>Matos, Jeffrey A.</au><au>Fisher, John D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prediction of sudden death and spontaneous ventricular tachycardia in survivors of complicated myocardial infarction: Value of the response to programmed stimulation using a maximum of three ventricular extrastimuli</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1985-06</date><risdate>1985</risdate><volume>5</volume><issue>6</issue><spage>1292</spage><epage>1301</epage><pages>1292-1301</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>The prognostic significance of ventricular arrhythmias induced by programmed electrical stimulation was evaluated in 50 survivors of acute myocardial infarction complicated by a major new conduction disturbance (38 patients), congestive heart failure (33 patients) or sustained ventricular tachyarrhythmias (22 patients), alone or in combination. Programmed stimulation was performed in patients in stable condition 7 to 36 days (mean 16) after infarction using one to three extrastimuli at four times diastolic threshold at a maximum of two right ventricular sites. Two groups were identified by the response to programmed stimulation: 17 patients with sustained (>15 seconds) or nonsustained (>7 beats but ≤15 seconds) ventricular tachycardia (group I), and 33 patients with 0 to 7 intraventricular reentrant complexes in response to maximal stimulation efforts (group II). Group I patients had a higher incidence of anterior infarction than that of patients in group II (71 versus 42%), had lower left ventricular ejection fraction (mean 0.35 versus 0.48) and were more often treated with antiarrhythmic drugs (47 versus 18%, p < 0.05). There were no significant differences between groups in the occurrence of congestive failure, new conduction disorders or sustained ventricular arrhythmias with infarction, or in the proportions treated with a beta-receptor blocking agent, coronary bypass grafting or a permanent pacemaker.
Total cardiac mortality was 24% during a mean follow-up period of 23 months and did not differ between groups; however, the response to programmed stimulation identified a group at high risk of late sudden death or spontaneous ventricular tachycardia: 7 (41%) of 17 group I patients compared with 0 of 33 group II patients (p < 0.001). The induction of sustained or nonsustained ventricular tachycardia identified all patients who died suddenly or had spontaneous tachycardia (sensitivity 100%), but triple extrastimuli were required to induce prognostically significant arrhythmias in five of these seven patients; the specificity of this protocol was only 57%. When the clinical variables of the group were evaluated individually, the response to programmed stimulation had a stronger association with occurrence of late sudden death than did any other factor (Fisher's exact test, p < 0.001); however, a type II error could not be excluded.
Thus, programmed ventricular stimulation using a maximum of three extrastimuli may be a sensitive but relatively nonspecific method for identifying survivors of complicated infarction at high risk of late sudden death or spontaneous ventricular arrhythmias.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>2582016</pmid><doi>10.1016/S0735-1097(85)80339-9</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Aged Biological and medical sciences Cardiac Complexes, Premature - etiology Cardiac Complexes, Premature - physiopathology Cardiology. Vascular system Coronary heart disease Death, Sudden - etiology Electric Stimulation Electrocardiography Female Follow-Up Studies Heart Heart - physiopathology Humans Male Medical sciences Middle Aged Myocardial Infarction - complications Myocardial Infarction - mortality Myocardial Infarction - physiopathology Risk Tachycardia - etiology |
title | Prediction of sudden death and spontaneous ventricular tachycardia in survivors of complicated myocardial infarction: Value of the response to programmed stimulation using a maximum of three ventricular extrastimuli |
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