Evaluation for Electrical Instability

The risk of sudden cardiac death in survivors of MI with normal ejection fraction is low, whereas patients with an ejection fraction <35-40% have a 10% risk of sudden cardiac death over 3.5 yr; 6-8% in the first yr and 2-4%/yr thereafter (127). In GISSI 2, the prevalence of frequent ventricular ectopy (>10 PVC/h) was 20% in 8676 patients, which is not significantly different than the frequencies reported in the prethrombolytic era (128). The predictive accuracy for cardiac events is lower in the postthrombolytic patient (Table 9) (128-132).

In GUSTO, Singh et al. (133) reported lower heart rate variability (HRV) 24 h after AMI in patients with anterior vs nonanterior MI (SDANN 53 ± 21 vs 63 ± 24 ms; p < 0.005), increased HRV with TIMI II flow low frequency [LF] 5.3 ± 1.0 vs 4.8 ± 1.2 ms2; p < 0.01), and lower HRV in those who died at 1 yr compared to survivors.

Table 9

Prevalence of Frequent PVCs (>10/h), Risk of SCD, Sensitivity, Specificity, and PPA of Frequent PVCs to Predict SCD and Sustained Ventricular Arrhythmias3

Table 9

Prevalence of Frequent PVCs (>10/h), Risk of SCD, Sensitivity, Specificity, and PPA of Frequent PVCs to Predict SCD and Sustained Ventricular Arrhythmias3

Study

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