Incidence of T wave alternation after acute myocardial infarction and correlation with other prognostic parameters: results of a prospective study.

Tachycardia induced alternation of the T wave (TWA) has been associated with arrhythmia morbidity in mixed patient populations. However, less is known concerning the general incidence of TWA and its usefulness in risk stratification early after acute myocardial infarction (MI). TWA was prospectively and systematically assessed in 140 consecutive patients 15 +/- 6 days after acute MI and prior to discharge. Results of TWA measurements were compared to other noninvasive risk markers, LV function, and coronary angiography. Sustained TWA was present at rest or inducible during exercise in 27% of patients. The patient-specific heart rate for the onset of TWA was 98 +/- 9 beats/min. After multivariate analysis, TWA correlated with age (P = 0.02) and LV function (P = 0.002) and occurred more often in patients after nonanterior MI (P = 0.03). Acute results of Holter monitoring, late potentials by signal-averaged ECG, and heart rate variability were unrelated to the TWA status. During follow-up (451 +/- 210 days) two major arrhythmic events occurred. The incidence of TWA early after MI is about 25%. TWA is related to age and LV function but not to other common arrhythmia markers. Although TWA does not appear to be related to excessive cardiac morbidity, evaluation of the prognostic significance of TWA requires further study.

Results and significance of Holter monitoring after direct percutaneous transluminal coronary angioplasty for acute myocardial infarction.

Whether acute and direct percutaneous transluminal coronary angioplasty improves the incidence of nonsustained ventricular tachycardia in patients surviving acute myocardial infarction is not known. In 400 consecutively studied patients, Lown classification IVb on Holter monitoring was only associated with arrhythmia morbidity, whereas reduced ejection fraction was related to total and cardiac mortality and arrhythmia morbidity.

Nonsustained, asymptomatic ventricular tachycardia in patients with coronary artery disease: prognosis and incidence of sudden death of patients who are noninducible by electrophysiological testing.

The objective of this study was to determine the long-term prognosis and the sudden death risk for patients with coronary artery disease and spontaneous nonsustained ventricular tachycardia who are not inducible by electrophysiological testing. Patients with coronary artery disease (CAD) who have spontaneous or inducible sustained ventricular tachycardia (VT) by electrophysiological testing are at increased risk of dying suddenly, and noninducibility is often considered as a favorable prognostic factor in their risk assessment. We studied 120 consecutive patients with CAD and nonsustained VT during Holter monitoring and followed the patients who were noninducible (n = 93) for 3.5 +/- 1.6 years. None of these patients received antiarrhythmic therapy except beta-blockade. Overall mortality and the sudden death risk was assessed by the Kaplan-Meier estimation. Predictors for overall mortality and sudden death were determined by multivariate analysis. During follow-up, 23 of the 93 patients died, including 13 suddenly. Overall mortality was 9% after 1 year, 16% after 2 years, and 21% after 3 years, respectively. The incidence of sudden death was 1% after 1 year, 8% after 2 years, and 13% after 3 years, respectively. Patients with a LVEF < or = 0.35 had an increased overall mortality risk with 15% after 1 year, 29% after 2 years, and 34% after 3 years (P = 0.012) and a risk of dying suddenly of 4% after 1 year, 12% after 2 years, and 18% after 3 years (P = NS), respectively. LVEF was the only independent predictor for overall mortality. In conclusion, patients with coronary artery disease and nonsustained ventricular tachycardia who are not inducible by electrophysiological testing have a moderate long-term overall mortality risk. The risk of dying suddenly in this patient group is small but not negligible, especially in patients with impaired LVEF.