Relation between acute ventricular arrhythmias, ventricular late potentials and mortality in acute myocardial infarction

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      The relation between ventricular late potentials and the occurrence of acute (in-hospital) and hyperacute (before hospital admission) ventricular tachycardia or fibrillation was studied in 281 consecutive patients with uninterrupted acute myocardial infarction. The prevalence of late potentials was significantly higher in patients with than without ventricular tachycardia/fibrillation (65 vs 22%; p < 0.01). These relations persisted among patients with left bundle branch block, although a different definition was used for identifying late potentials in these patients. Multivariate analysis showed that presence of late potentials and peak creatine kinase enzyme level were the only 2 independent variables associated with early ventricular tachycardia/fibrillation.
      Total in-hospital mortality, as well as in-hospital cardiac mortality, was significantly higher among patients with than without acute ventricular tachycardia/fibrillation. However, at 1 year, mortality rates did not differ between the 2 groups.
      The following conclusions were drawn from this study: (1) Late potentials are closely related to ventricular tachycardia/fibrillation in hyperacute and acute phases of infarction. (2) Presence of left bundle branch block does not mitigate against the finding of late potentials in these patients. (3) Early ventricular tachycardia/fibrillation in acute infarction is related to large infarctions and to a high in-hospital mortality rate.
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        • Simson MB
        Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction.
        Circulation. 1981; 64: 235-242
        • Denniss AR
        • Richards DA
        • Cody DV
        • Russell PA
        • Young AA
        • Cooper MJ
        • Ross DL
        • Uther JB
        Prognostic significance of ventricular tachycardia and fibrillation induced at programmed stimulation and delayed potentials detected on the signal-averaged electrocardiograms of survivors of acute myocardial infarction.
        Circulation. 1986; 74: 731-745
        • Kanovsky MS
        • Falcone RA
        • Dresden CA
        • Josephson ME
        • Simson MB
        Identification of patients with ventricular tachycardia after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring, and cardiac catheterization.
        Circulation. 1984; 70: 264-270
        • Zimmermann M
        • Adamec R
        • Simonin P
        • Richez J
        Prognostic significance of ventricular late potentials in coronary artery disease.
        Am Heart J. 1985; 109: 725-732
        • Breithardt G
        • Borggrefe M
        • Schwarzmaler J
        • Haerten K
        • Seipel L
        Prognostic significance of late potentials after acute myocardial infarction.
        Eur Heart J. 1983; 4: 487-495
        • Kuchar DL
        • Thorburn CW
        • Sammel NL
        Prediction of serious arrhythmic events after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring and radionuclide ventriculography.
        J Am Coll Cardiol. 1987; 9: 531-538
        • Verzoni A
        • Romano S
        • Pozzoni L
        • Tarricone D
        • Sangiorgio S
        • Croce L
        Prognostic significance and evolution of late ventricular potentials in the first year after myocardial infarction: a prospective study.
        PACE. 1989; 12: 41-51
        • Ohnishi Y
        • Inoue T
        • Fukuzaki H
        Value of the signal-averaged electrocardiogram as a predictor of sudden death in myocardial infarction and dilated cardiomyopathy.
        Jpn Circ J. 1989; 54: 127-136
        • Kuchar DL
        • Thorburn CW
        • Freund J
        • Yeates MG
        • Sammel NL
        Noninvasive predictors of cardiac events after myocardial infarction.
        Cardiology. 1989; 76: 18-31
        • Kuchar DL
        • Thorburn CW
        • Sammel NL
        Late potentials detected after myocardial infarction: natural history and prognostic significance.
        Circulation. 1986; 74: 1280-1289
        • El-Sherif N
        • Ursell SN
        • Bekheit S
        • Fontaine J
        • Turitto G
        • Henkin R
        • Caref EB
        Prognostic significance of the signal-averaged ECG depends on the time of recording in the post infarction period.
        Am Heart J. 1989; 118: 256-264
        • McGuire M
        • Kuchar D
        • Ganis J
        • Sammel N
        • Thorburn C
        Natural history of late potentials in the first ten days after acute myocardial infarction and relation to early ventricular arrhythmias.
        Am J Cardiol. 1988; 61: 1187-1190
        • Dluzniewski M
        • Kulakowski P
        • Senatorski M
        • Ceremuzynski L
        Late potentials in the acute phase of myocardial infarction indicate the risk of early ventricular fibrillation.
        Eur Heart J. 1988; 9: 1175-1180
        • Kertes PJ
        • Glabus M
        • Murray A
        • Julian DG
        • Campbell RWF
        Delayed ventricular depolarization—correlation with ventricular activation and relevance to ventricular fibrillation in acute myocardial infarction.
        Eur Heart J. 1984; 5: 974-983
        • Lewis SJ
        • Lander PT
        • Taylor PA
        • Chamberlain DA
        • Vincent R
        Evolution of late potential activity in the first six weeks after acute myocardial infarction.
        Am J Cardiol. 1989; 63: 647-651
        • Nicod P
        • Gilpin E
        • Dittrich H
        • Wright M
        • Engler R
        • Rittlemeyer J
        • Henning H
        • Ross J
        Late clinical outcome in patients with early ventricular fibrillation after myocardial infarction.
        J Am Coll Cardiol. 1988; 11: 464-470
        • Volpi A
        • Maggioni A
        • Franzosi MG
        • Pampallona S
        • Mauri F
        • Tognoni G
        In-hospital prognosis of patients with acute myocardial infarction complicated by primary ventricular fibrillation.
        N Engl J Med. 1987; 317: 257-261
        • Chew E
        • Morton P
        • Murtagh JG
        • Scott ME
        • O'Keeffe DB
        Intravenous streptokinase for acute myocardial infarction reduces the occurrence of ventricular late potentials.
        Br Heart J. 1990; 64: 5-8
        • Gang ES
        • Lew AS
        • Ma H
        • Wang FZ
        • Vaughn CA
        • Peter T
        Decreased incidence of ventricular late potentials after successful thrombolytic therapy for acute myocardial infarction.
        N Engl J Med. 1989; 321: 712-716
        • Vermeer F
        • Simoons ML
        • Lubsen J
        Reduced frequency of ventricular fibrillation after early thrombolysis in myocardial infarction.
        Lancet. 1986; 1: 1147-1148
        • Borbola J
        • Serry C
        • Goldin M
        • Denes P
        Short-term effect of coronary artery bypass grafting on the signal-averaged electrocardiogram.
        Am J Cardiol. 1988; 61: 1001-1005
        • Grimm MG
        • Billhardt RA
        • Mayerhofer KE
        • Denes P
        Prognostic significance of signal-averaged ECGs during acute myocardial infarction: a preliminary report.
        J Electrocardiol. 1988; 21: 283-288
        • Harris AS
        • Rojas AG
        Initiation of ventricular fibrillation due to coronary occlusion.
        Exp Med Surg. 1943; 1: 105-122
        • Boineau JP
        • Cox JL
        Slow ventricular activation in acute myocardial infarction. A source of re-entrant premature ventricular contractions.
        Circulation. 1973; 48: 702-713
        • Waldo AL
        • Kaiser GA
        A study of ventricular arrhythmias associated with acute myocardial infarction in the canine heart.
        Circulation. 1973; 47: 1222-1228
        • Lazzara R
        • El-Sherif N
        • Scherlag BJ
        Early and late effects of coronary artery occlusion on canine purkinje fibers.
        Circ Res. 1974; 35: 391-399