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European Heart Journal Advance Access originally published online on January 20, 2009
European Heart Journal 2009 30(6):689-698; doi:10.1093/eurheartj/ehn537
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
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Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction{dagger}

Heikki V. Huikuri1,*, M.J. Pekka Raatikainen1, Rikke Moerch-Joergensen2, Juha Hartikainen3, Vesa Virtanen4, Jean Boland5, Olli Anttonen6, Nis Hoest7, Lucas V.A. Boersma8, Eivind S. Platou9, Marc D. Messier10, Poul-Erik Bloch-Thomsen2 for the Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction (CARISMA) study group

1 Department of Internal Medicine, University of Oulu, PO Box 5000 (Kajaanintie 50), 90014 Oulu, Finland
2 Gentofte University Hospital, Copenhagen, Denmark
3 Department of Internal Medicine, University of Kuopio, Kuopio, Finland
4 Department of Cardiology, University of Tampere, Tampere, Finland
5 Department of Internal Medicine, Hopital Citadelle, Liege, Belgium
6 Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
7 Glostrup Hospital, Copenhagen, Denmark
8 St Antonious Hospital, Nieuwegein, The Netherlands
9 Department of Cardiology, Center for Arrhythmias, Ullevål University Hospital, Oslo, Norway
10 Medtronic Bakken Research Center, Maastricht, The Netherlands

Received 25 April 2008; revised 30 October 2008; accepted 6 November 2008; online publish-ahead-of-print 20 January 2009.

* Corresponding author. Tel: +358 8 315 4108, Fax: +358 8 315 5599, Email: heikki.huikuri{at}oulu.fi

Aims: To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF ≤ 0.40).

Methods and results: A total of 5869 consecutive patients were screened in 10 European centres, and 312 patients (age 65 ± 11 years) with a mean LVEF of 31 ± 6% were included in the study. Heart rate variability/turbulence, ambient arrhythmias, signal-averaged electrocardiogram (SAECG), T-wave alternans, and programmed electrical stimulation (PES) were performed 6 weeks after AMI. The primary endpoint was ECG-documented ventricular fibrillation or symptomatic sustained ventricular tachycardia (VT). To document these arrhythmic events, the patients received an implantable ECG loop-recorder. There were 25 primary endpoints (8.0%) during the follow-up of 2 years. The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms2) adjusted for clinical variables was 7.0 (95% CI: 2.4–20.3, P < 0.001). Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7–13.4, P = 0.003) also predicted the primary endpoint.

Conclusion: Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI.

Key Words: Sudden cardiac death • Heart rate • Variability • Implantable cardioverter-defibrillator

{dagger} Results of the cardiac arrhythmias and risk stratification after acute myocardial infarction study.


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