Prognostic significance of ventricular late potentials in the postmyocardial infarction period

Abstract

Ventricular late potentials in patients after myocardial infarction can be assumed to herald an increased risk of future sudden cardiac death or symptomatic sustained ventricular tachycardia. This holds particularly true for patients studied early after recent myocardial infarction whereas patients assessed later in the subsequent course have a substantially lesser incidence of arrhythmic events, probably due to intercurrent death of those at high risk. Of prognostic importance appears not only the presence but also the duration of late potentials. A meaningful role is also assumed by the extent of left ventricular functional impairment (EF less than 40%). However, in consideration of the complex mechanisms that can lead to sudden cardiac death, no single method predicts with high sensitivity the occurrence of a ventricular tachyarrhythmic event. Sudden cardiac death can be incurred on the basis of chronic electrophysiological abnormalities as a consequence of regional slow conduction in the border zone of a previous myocardial infarction precipitated by trigger factors such as spontaneous ventricular arrhythmias. Sudden cardiac death or symptomatic sustained ventricular tachycardia can also occur due to sudden and transient changes in the electrophysiological properties of the myocardium due to ischemia. Whether the combination of late potentials with clinical parameters such as ventricular arrhythmias detected in the ambulatory ECG and those induced with programmed electrical stimulation will lead to more accurate identification of patients at risk prerequisites further elucidation. Currently available literature indicates that in patients with late potentials, ventricular tachycardias can be induced more frequently by programmed electrical stimulation and that the combination of both phenomena confers a particularly high risk.