[Long-term prognosis of myocardial infarction. Value of Holter monitoring]

Abstract

The mortality one year after a myocardial infarction varies between 2 and 60% according to the subjects. Thus, there is a group of patients at high risk of sudden death which it is important to be able to define. These patients are characterised by a lesion of the left ventricle with a decrease in the ejection fraction to below 0.40 and the presence of disorders of ventricular excitability on the Holter recording. This examination is able to demonstrate the signs of severity of the extrasystoles by showing an elevated number of ventricular extrasystoles (VEB) (greater than 1%) and the appearance in pairs or in runs. 24 hour Holter monitoring may miss a complex arrhythmia and the increase in the duration of the monitor increase the sensitivity. However, it should be associated with an evaluation of the ejection fraction and possible with invasive investigations such as programmed ventricular stimulation in high risk patients.