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European Heart Journal 1991 12(11):1170-1175;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Relationship between signal-averaged electrocardiography and dangerous ventricular arrhythmias in patients with left ventricular aneurysm after myocardial infarction

P. KULAKOWSKI, M. DLUZNIEWSKI, A. BUDA$$$ and L. CEREMUZYNSKI

II Department of Cardiology, Medical Centre of Postgraduate Education, Grochowski Hospital Warsaw, Poland

Received 22 April 1990; revised 10 October 1990; .

Correspondence: Piotr Kulakowski MD, Department of Cardiological Sciences. St George's Hospital Medical School, Cranmer Terrace, London SWI7 ORE. UK

Abstract

We performed signal-averaged electrocardiography (SAECG) and Holter monitoring, and subsequently followed-up 53 ambulatory patients with left ventricular aneurysm (LVA) after myocardial infarction (MI). A history of spontaneous episodes of sustained ventricular tachycardia (VT) v also analysed.

Out of 53 patients, 25 (47%) had an abnormal SAECG. Abnormal SAECG correctly identified nine out of 10 cases with a history of sustained VT. Complex ventricular arrhythmias were detected on Holler monitoring in 23 patients: in five out of 28 with normal SAECG (18%) and in 18 out of 25 with abnormal SAECG (72%) (P<0001). During follow-up (mean 19 months) sustained VT and/or sudden cardiac death (SCD) occurred in eight cases, out of which seven had an abnormal SAECG. The negative predictive value of SAECG (no VT or SCD during follow-up) was very high, 96%. similar to the negative predictive value of a history of sustained VT (93%). Using multivariate analysis only a history of sustained VT twas an independent factor in predicting the outcome of patients in this study.

We conclude that an abnormal SAECG identifies those post infarction patients with LVA who are prone to complex ventricular arrhvthmias. A normal SAECG and an absence of a history of sustained VT strongly indicate that the risk of developing arrhythmic events is very low.

Key Words: Signal-averaged electrocardiography • left ventricular aneurysm • ventricular arrhythmias • sudden cardiac death


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