Determinants of induction of ventricular tachycardia in nonsustained ventricular tachycardia after myocardial infarction and the usefulness of the signal-averaged electrocardiogram

• Published in: The American journal of cardiology Vol. 72; no. 17; pp. 1281 - 1285
• Main Authors: Winters, Stephen L., Ip, John, Deshmukh, Pramod, DeLuca, Alfred, Daniels, Kathleen, Pe, Elena, Gomes, J.Anthony
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.1993; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiac arrhythmia; Cardiology. Vascular system; Coronary heart disease; Electrocardiography; Female; Health care; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - physiopathology; Signal Processing, Computer-Assisted; Survival Analysis; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Human; Arrhythmia; Infarct; Cardiovascular disease; Coronary heart disease; Excitability disorder; Electrodiagnosis; Instrumental stimulation; Heart disease; Risk factor; Electrocardiography; Myocardium; Diagnosis; Paroxysmal ventricular tachycardia
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(93)90297-P

Assessment of the implications of clinical and noninvasive variables, including the results of signal-averaged electrocardiography, was performed ≥3 weeks after myocardial infarction in 57 patients with nonsustained ventricular tachycardia (VT) who underwent programmed ventricular stimulation to guide antiarrhythmic therapy. The clinical and noninvasive parameters assessed included ages, left ventricular ejection fractions, sites of infarction, presence of akinetic or dyskinetic left ventricular segments, history of syncope, history of coronary artery bypass surgery, and presence or absence of late potentials from signal-averaged electrocardiography. Other than the presence of late potentials, no clinical or non-invasive parameters identified such persons with a significantly higher likelihood of inducible VT. When assessed as positive if 1 or more variables were abnormal, 16 of 16 (100%) patients with versus 17 of 41 without inducible VT had late potentials (p < 0.002). With more stringent criteria required (defined as prolongation of the QRS vector complex duration and low root-mean-square voltage of the terminal 40 ms of the vector complex) 8 of 16 patients (50%) with and 4 of 41 (10%) without inducible VT had late potentials recorded (p < 0.002). Thus, the signal-averaged electrocardiogram may enable identification of persons with nonsustained VT after myocardial infarction who are most likely to have VT induced at programmed ventricular stimulation.