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European Heart Journal 1994 15(7):928-933;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Value of ambulatory electrocardiographic monitoring to identify increased risk of sudden death in patients with left ventricular dysfunction and heart failure

B. M. SZARÓ, D. J. VAN VELDHUISEN, H. J. G. M. CRUNS, A. C. P. WIESFELD, H. L. HILLEGE and K. I. LIE

Department of Cardiology/Thoraxcenter, University Hospital Groningen The Netherlands

Received 5 October 1993; revised 1 February 1994; .

Correspondence: Balázs M Szabó, MD, Department of Cardiology/Thoraxcenter, University Hospital Gromngen, Oostersingel 59, 9713 EZ Groningen, The Netherlands.

Abstract

To examine the predictive value of ventricular arrhythmias on ambulatory electrocardiographic (ECG) monitoring, 211 patients with left ventricular dysfunction and congestive heart failure (76% men, age 63±4 years, left ventricular ejection fraction 0.26 ± 0.10) were studied. During a follow-up of 21 ± 11 months, there were 45 cardiac deaths: 22 were due to progressive pump failure and 23 were sudden. Patients with a low left ventricular ejection fraction ( ≤0.27) and ventricular tachycardia on 24 h ECG were at higher risk of dying suddenly and from progressive pump failure (both P<0.0001). Patients who died suddenly were found to have significantly longer (P=0.003) and faster (P=0.029) ventricular tachycardias on their baseline ambulatory ECG, than survivors. This association was not observed in patients who died of progressive pump failure. Therefore, low left ventricular ejection fraction and ventricular tachycardia on 24 h ECG recording predict an increased risk of cardiac mortality. Our results also suggest that longer and faster ventricular tachycardia recorded by 24 h ECG may identify patients at risk of sudden death, a finding which has not been described before.

Key Words: Heart failure • sudden death • risk identification • ambulatory ECG


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