Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2009 Mar;30(6):689-98.
doi: 10.1093/eurheartj/ehn537. Epub 2009 Jan 20.

Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction

Heikki V Huikuri  1 , M J Pekka Raatikainen, Rikke Moerch-Joergensen, Juha Hartikainen, Vesa Virtanen, Jean Boland, Olli Anttonen, Nis Hoest, Lucas V A Boersma, Eivind S Platou, Marc D Messier, Poul-Erik Bloch-Thomsen; Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction study group
Affiliations
Multicenter Study

Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction

Heikki V Huikuri et al. Eur Heart J. 2009 Mar.

Abstract

Aims: To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF < or = 0.40).

Methods and results: A total of 5869 consecutive patients were screened in 10 European centres, and 312 patients (age 65 +/- 11 years) with a mean LVEF of 31 +/- 6% were included in the study. Heart rate variability/turbulence, ambient arrhythmias, signal-averaged electrocardiogram (SAECG), T-wave alternans, and programmed electrical stimulation (PES) were performed 6 weeks after AMI. The primary endpoint was ECG-documented ventricular fibrillation or symptomatic sustained ventricular tachycardia (VT). To document these arrhythmic events, the patients received an implantable ECG loop-recorder. There were 25 primary endpoints (8.0%) during the follow-up of 2 years. The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms(2)) adjusted for clinical variables was 7.0 (95% CI: 2.4-20.3, P < 0.001). Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7-13.4, P = 0.003) also predicted the primary endpoint.

Conclusion: Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI.

Trial registration: ClinicalTrials.gov NCT00145119.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study Flow Chart. *Major reasons for exclusions from the study were refusal of the patient or the attending physician treating the patient for participation in the study (n = 380), the inability of the patient to participate in the study due to other serious illness (n = 312), planned coronary bypass graft surgery (n = 184) or death (n = 89) before the implantation of a loop-recorder and/or the risk stratification tests. AMI, acute myocardial infarction; EP, electrophysiological; ILR, implantable loop-recorder; SAECG, signal-averaged electrocardiogram; TWA, T-wave alternans.
Figure 2
Figure 2
Clinical presentation, type of documented arrhythmia, and the mode of documentation of primary endpoints. ICD, implantable cardioverter-defibrillator; ILR, implantable loop-recorder; VT, ventricular tachycardia; VF, ventricular fibrillation.
Figure 3
Figure 3
Adjusted hazard ratios (HR) with 95% confidence intervals of the variables as predictors of primary endpoint. HR are calculated from pre-defined threshold values of continuous variables. HR are adjusted for age, prior myocardial infarction, history of congestive heart failure and diabetes The variables are listed in descending order starting with the highest HR for each risk stratification method. Abbreviations: see in Table 3.
Figure 4
Figure 4
Kaplan–Meier estimate of the time from MI to primary endpoint, stratified by inducible sustained monomorphic ventricular tachycardia (MMVT) (panel A) and by reduced very-low frequency spectral component (VLF) of heart rate variability (panel B).
See this image and copyright information in PMC

Comment in

References

    1. Camm AJ, Pratt CM, Schwartz PJ, Al-Khalidi HR, Spyt MJ, Holroyde MJ, Karam R, Sonnenblick EH, Brum JM AzimiLide post Infarct surVival Evaluation (ALIVE) Investigators. Mortality in patients after a recent myocardial infarction: a randomized, placebo-controlled trial of azimilide using heart rate variability for risk stratification. Circulation. 2004;109:990–996. - PubMed
    1. Solomon SD, Zelenkofske S, McMurray JJ, Finn PV, Velazquez E, Ertl G, Harsanyi A, Rouleau JL, Maggioni A, Kober L, White H, Van de Werf F, Pieper K, Califf RM, Pfeffer MA Valsartan in Acute Myocardial Infarction Trial (VALIANT) Investigators. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med. 2005;352:2581–2588. - PubMed
    1. Hohnloser SH, Kuck KH, Dorian P, Roberts RS, Hampton JR, Hatala R, Fain E, Gent M, Connolly SJ DINAMIT Investigators. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. 2004;351:2481–2488. - PubMed
    1. Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med. 2001;345:1473–1482. - PubMed
    1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–883. - PubMed

Publication types

MeSH terms

Associated data