Late Hospital Phase Research Articles

Electrocardiography changes in patients with acute myocardial infarction in late hospital phase

One of possibilities to estimate size of myocardial injury during the acute myocardial infarction are electrocardiographic changes, forming of QS formation (ECG signs of scares changes). This investigation which included three groups of patients receiving thrombolytic, nitrates or beta blockers in acute phase of myocardial infarction has aim to analyze 12-chanels electrocardiogram and to establish difference between this therapeutics groups in sum of QRS score, but also to indication frequency of periinfarction heart insufficiency in this therapeutics groups, comparing with observed ECG changes. Analysis shows significant differences between groups in value of QRS score, and also significant lower value of QRS score in patients with acute myocardial infarction treated with thrombolytic therapy. This difference relative to other two groups shows lower level of myocardial injury during acute myocardial infarction in patients treating with thrombolytic therapy.

Effect of thrombolytic therapy on occurrence of complex ventricular arrhythmias in the late hospitalization period in acute myocardial infarct: relation with long-term remodeling of the left ventricle

The impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias is not yet clarified. The aim of this study was to investigate the impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias, as well as long term association between complex ventricular arrhythmias and left ventricular remodelling, and their impact on five-year lethality. Ninety seven consecutive patients with first acute myocardial infarction (streptokinase was administered in 58 patients), underwent 24-hours Holter monitoring at discharge. Ventricular arrhythmias were classified according to Lown classification, and patients were grouped into the group with simple ventricular arrhythmias (Lown class 0 to 2), and the group with complex ventricular arrhythmias (Lown class 3 to 5). Echocardiography was performed at discharge, and six and twelve months after the infarction. Left ventricular volume indexes and ejection fraction was determined using Simpson's biplane formula. In patients with complex ventricular arrhythmias left ventricular volume indexes were higher and ejection fraction was lower throughout the study, whereas wall motion score index was higher one year after the infarction. On the other hand, these variables were similar throughout the follow-up within the groups of patients with and without complex ventricular arrhythmias who received thrombolytic therapy. The incidence of complex ventricular arrhythmias was similar in thrombolyzed and non-thrombolyzed patients (11/58 vs. 5/39). There was no difference in five year lethality between patients with and without complex ventricular arrhythmias (4/16 vs. 13/81 patients). Our data indicated that left ventricular remodelling in patients with complex ventricular arrhythmias was not progressive after hospital discharge. The presence of complex ventricular arrhythmias was not associated with the increased five-year lethality, despite of more pronounced left ventricular remodelling. It occurred that thrombolysis per se had no influence on the incidence of complex ventricular arrhythmias in the late hospital phase after the first acute myocardial infarction.

Transmission of Ebola hemorrhagic fever: a study of risk factors in family members, Kikwit, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit.

The surviving members of 27 households in which someone had been infected with Ebola virus were interviewed in order to define the modes of transmission of Ebola hemorrhagic fever (EHF). Of 173 household contacts of the primary cases, 28 (16%) developed EHF. All secondary cases had direct physical contact with the ill person (rate ratio [RR], undefined; P < .001), and among those with direct contact, exposure to body fluids conferred additional risk (RR, 3.6; 95% confidence interval [CI], 1.9-6.8). After adjusting for direct contact and exposure to body fluids, adult family members, those who touched the cadaver, and those who were exposed during the late hospital phase were at additional risk. None of the 78 household members who had no physical contact with the case during the clinical illness were infected (upper 95% CI, 4%). EHF is transmitted principally by direct physical contact with an ill person or their body fluids during the later stages of illness.

Cardioprotective effect of unstable angina prior to acute anterior myocardial infarction.

To evaluate the difference in the process of left ventricular functional recovery after successful percutaneous transluminal coronary angioplasty (PTCA), 25 patients with sudden onset of acute Q wave anterior myocardial infarction (MI [group 1]) and 28 patients with unstable angina prior to MI (group 2) were investigated in the late hospital phase. The circumferential extent of left ventricular dysfunction was significantly larger in group 1 than in group 2. The left ventricular ejection fraction (EF) and the ratio of systemic arterial systolic blood pressure to left ventricular end-systolic volume (P/V ratio) were significantly lower in group 1 compared with group 2. The P/V ratio had nonlinear relationships with left ventricular end-diastolic volume (LVEDV) in both groups and the P/V ratio in group 1 was significantly lower than those in group 2 at any given LVEDV. Thus, in patients with successful PTCA, unstable angina prior to acute MI had better left ventricular pump function in the course of left ventricular remodeling.

Regional cardiac adrenergic function using I-123 meta-iodobenzylguanidine tomographic imaging after acute myocardial infarction

The effect of acute myocardial infarction (AMI) on regional cardiac adrenergic function was studied in 27 patients mean ± standard deviation 10 ± 4 days after AMI. Regional adrenergk function was evaluated noninvasively with I-123 meta-iodobenzylguanidine (MIBG) using a dedicated 3-detector tomograph. Four hours after its administration, there was reduced MIBG uptake in the region of infarction, 0.38 ± 0.31 counts/pixel/mCi × 103 compared with 0.60 ± 0.30 counts/pixel/mCi × 103 and 0.92 ± 0.35 counts/pixel/mCi × 103 in the zones bordering and distant from the infarct area, respectively, p < 0.001. In all patients, the area of reduced MIBG uptake after 4 hours was more extensive than the associated thallium-201 perfusion defect with defect scores of 52 ± 22 and 23 ± 18%, respectively, p < 0.001. After anterior wall AMI, the 4-hour MIBG defect score was 70 ± 13% and the degree of mismatch between myocardial perfusion and MIBG uptake was 30 ± 9% compared with 39 ± 17 and 21 ± 17% after inferior AMI, p < 0.001 and p = 0.016, respectively. The 4-hour MIBG defect score correlated inversely with the predischarge left ventricular ejection fraction, r = −0.73, p < 0.001. Patients with ventricular arrhythmia of ≥1 ventricular premature complexes per hour, paired ventricular premature complexes or ventricular tachycardia detected during the late hospital phase had higher 4-hour MIBG defect scores, 62.5 ± 15.0%, than patients with no detectable complex ventricular ectopic activity and a ventricular premature complex frequency of <1 per hour, 44.6 ± 23.4%, p = 0.036. These data suggest that after acute AMI in humans (1) the abnormality in adrenergic function is more extensive than the associated abnormality in myocardial perfusion; (2) anterior wall AMI is associated with greater disruption of cardiac adrenergic function than other infarcts; (3) the severity of cardiac adrenergic dysfunction correlates with the degree of left ventricular dysfunction; and (4) the abnormality in regional adrenergic function may be associated with the presence of ventricular ectopic activity after AMI.

Frequency, characteristics and significance of supraventricular tachyarrhythmias detected by 24-hour electrocardiographic recording in the late hospital phase of acute myocardial infarction

The incidence, characteristics and clinical significance of supraventricular tachyarrhythmias occurring in the late hospital phase of acute myocardial infarction (AMI) were assessed in 209 consecutive patients. Arrhythmias were quantified by 24-hour electrocardiographic recording 16 ± 3 days after AMI, and were classified according to the degree of complexity in 5 classes. Class 0 = <5 premature beats/hr; class 1 = between 5 and 100/hr; class 2 = >100/hr or repetitive premature beats; class 3 = atrial-junctional tachycardia; class 4 = atrial flutter-fibrillation. Supraventricular tachyarrhythmias classes 1 to 2 always occurred in the absence of symptoms in 86 patients (41%); supraventricular tachyarrhythmias classes 3 to 4 (paroxysmal, self-limiting, brief) occurred in 27 patients (13%), symptomatically in 6. The presence of supraventricular tachyarrhythmias classes 2 to 3 was related to age over 55 years and complex ventricular tachyarrhythmias (>20 premature beats/hr, ventricular tachycardia) (both p < 0.05). Increasing complexity of supraventricular tachyarrhythmias was significantly associated with presence and entity of cardiac enlargement and left ventricular dysfunction (both p < 0.01). Patients with class 4 showed the most severe cardiac deterioration. During the 2 years after AMI, patients with classes 2, 3 and 4 had a higher incidence of acute pulmonary edema, New York Heart Association functional classes III to IV for congestive heart failure (both p < 0.005) and a greater need of digitalis and diuretics (p = 0.003). In these patients the probability of surviving 2 years was 79% compared to 94% in the remaining population (p = 0.002). Cox multiple regression analysis indicated that supraventricular tachyarrhythmia classes 2, 3 and 4 did not predict an increased risk of cardiac death independently from cardiac enlargement and left ventricular dysfunction. Arrhythmia monitoring in the late hospital phase of AMI should take into account complex supraventricular tachyarrhythmias because of their relation to left ventricular dysfunction and subsequent clinical course.

Diastolic Time and Systolic Time Intervals during Static Exercise in the Late Hospital Phase of Acute Myocardial Infarction

To evaluate diastolic time (DT) during static exercise, the DT-heart rate relation was studied by ear densitography in the late hospital phase of acute myocardial infarction. None of the patients had an ischemic electrocardiographic response. The patients were divided into 2 groups; group 1 comprised 12 patients with a resting left ventricular end-diastolic volume = 140 ml, and group 2 comprised 11 patients with a left ventricular enddiastolic volume < 140 ml. Electromechanical systole and heart rate had a linear inverse relation during sustained weight load exercise, while DT and heart rate had a nonlinear inverse relation (DT = e^7 51–0.019 × heart rate, DT = e^7 47–0.018 × heart rate, group 1 and 2, respectively). A significant prolongation of electromechanical systole with consequent shortening of DT (p < 0.01) was observed in group 1. In addition to a decrease in DT with increasing heart rate during a sustained weight load exercise, the disproportionate shortening of DT in patients with increased left ventricular end-diastolic volume has a potential for further impediment of subendocardial blood flow and consequently for accentuation of left ventricular dysfunction.

Association between extent of coronary artery disease and ventricular premature beat frequency after myocardial infarction

Severe coronary artery disease (CAD) and frequent ventricular premature beats (VPBs) on ambulatory ECG monitoring in the late hospital phase after myocardial infarction are independent predictors of prognosis. To study the relationship between extent of CAD and VPB frequency, 128 consecutive (91 men, 37 women) patients surviving 6 days after myocardial infarction underwent 24-hour ECG, coronary angiography, and left ventriculography. CAD was graded as zero to one-, two-, and three-vessel (V), and also by a previosly validated “jeopardy score” with 0 to 12 as grades of incremental CAD severity. Average VPB frequency was significantly correlated with CAD by V, CAD by jeopardy score, and by left ventricular ejection fraction ( p < 0.01 for all three). With the use of a multivariate ordinal logistic regression model, both VPB frequency and left ventricular ejection fraction were found to have independent association with CAD. The median VPB frequency was 1/hr, 0.6/hr, and 6/hr in zero to one-, two-, and three-V CAD, respectively (zero to one- and two-V CAD vs three-V CAD p < 0.01, one-V CAD vs two-V CAD p = NS). In conclusion, frequent VPBs following myocardial infarction are associated with extensive CAD and are independent of left ventricular ejection fraction. Therefore, the prognostic value of frequent VPBs may be related to severe underlying ischemic disease.

Left ventricular performance determined by ambulatory monitoring of systolic time intervals during daily activities in the late hospital phase of acute myocardial infarction

The ambulatory electrocardiogram is a useful method for detecting complex arrhythmias in the late hospital phase of acute myocardial infarction (AMI) and exercise testing is usually used to detect cardiac reserve or ischemia or both.1,2 However, the changes in left ventricular (LV) performance during various daily activities cannot always be reproduced by the standard exercise test. Systolic time interval calculation is a useful noninvasive measure of cardiac function; ear densitography makes possible precise observation of changes in systolic time intervals under various conditions including upright exercise.3–5 We investigated the long-term ambulatory response of systolic time intervals during daily activities in patients recovering from AMI to evaluate the changes in LV performance to daily stresses.

Incidence and prognostic implications of repetitive ventricular complexes during pre-discharge bicycle ergometry after myocardial infarction.

The clinical significance of repetitive ventricular complexes (RVCs) during pre-discharge bicycle ergometry after acute myocardial infarction has been assessed in 408 consecutive patients. RVCs occurred in 32 patients (8%). When compared to patients without RVCs, those with RVCs had a larger infarction, a higher prevalence of heart failure and late sustained ventricular tachycardia or fibrillation, a lower radionuclide ejection fraction and more frequent RVCs during pre-discharge 24-hour electrocardiographic monitoring. During a follow-up 30 patients died, 17 suddenly. Mortality was 15% (N = 5) in patients with RVCs during exercise test and 7% (N = 25) in those without RVCs. Sudden death occurred in only one patient with RVCs. When multivariate analysis was applied to clinical and exercise test data, RVCs during exercise did not predict cardiac mortality independent of variables related to left ventricular function, such as a history of previous myocardial infarction, persistence of heart failure in the late hospital phase and the extent of blood pressure rise during exercise test.

Supraventricular Arrhythmias in the Late Hospital Phase of Acute Q-Wave Myocardial Infarction: Supraventricular Arrhythmia in Myocardial Infarction

To assess the correlates of supraventricular arrhythmia (SA) in the late hospital phase of acute Q-wave myocardial infarction (MI), continuous 24-h ambulatory electrocardiographic monitoring, gated cardiac pool scan, modified exercise test, and chest x-ray were reviewed in 102 patients. Supraventricular tachyarrhythmias were seen in 11 patients, atrial premature beats in 42 patients; 49 patients did not have SA. Multiple discriminant analysis was used to determine the important variables contributing to the occurrence of SA. Variable included age, sex, history of previous MI, hypertension, location of MI, moist rales at time of admission, cardiothoracic ratio, ejection fraction, wall motion abnormality, exercise test result, duration of exercise and use of digitalis. Moist rales, digitalis, age and cardiothoracic ratio were the predictors of SA. Aging, hemodynamic change imposed on the left ventricle, and arrhythmic effects of digitalis are the major factors associated with SA in the late hospital phase of acute MI.

Prevalence, characteristics and significance of ventricular tachycardia detected by 24-hour continuous electrocardiographic recordings in the late hospital phase of acute myocardial infarction

A 24-hour continuous electrocardiographic recording was made 11 ± 3 days after acute myocardial infarction (AMI) in 820 of the 867 participants in the Multicenter Post-Infarction Program. Ninety patients (11%) had unsustained ventricular tachycardia (VT) and 2 (0.2%) had sustained VT (more than 15 seconds). In 53 of the 92 patients (58%) with VT, only 1 episode of VT was in the recording. In 26 patients the longest episode of VT was 3 consecutive complexes (28%); in 56 patients (61%) it was 4 to 10 complexes; and in only 10 patients (11%) were there more than 10 consecutive complexes. The average rate of VT was 121 ± 34 complexes per minute (range 75 to 240). Most episodes of VT started well after the T wave. Occurrence of VT was strongly related to the frequency of ventricular premature complexes in the 24-hour recording; 46% of the patients with at least 100 ventricular premature complexes per hour had VT. The 92 patients who had VT were compared to the 728 who did not with respect to relevant clinical characteristics. Several variables were significantly (p < 0.05) more common in the VT group: age older than 60 years, previous AMI, history of angina pectoris, occurrence of VT or ventricular fibrillation in the coronary care unit, left ventricular ejection fraction less than 30%, rales greater than bibasilar in the coronary care unit, and use of antiarrhythmic drugs, digitalis or diuretics at the time of discharge from hospital. Based on Kaplan-Meier survival curves, the cumulative probability of surviving 3 years was 0.67 for patients with VT and 0.85 for patients without VT (p < 0.001). There were no statistically significant associations between individual VT characteristics and mortality. However, patients with longer runs of VT tended to have a higher mortality rate, and both patients with sustained VT died in the first month after the index infarct. VT had a strong and statistically significant association (p < 0.05) with all-cause and arrhythmic mortality independent of other risk variables that were associated with VT. Adjusted for other risk indicators, VT nearly doubled the risk of dying during an average follow-up of 31 months.

The Gorlin syndrome: A genetically determined disorder associated with cardiac tumor

18. tory electrocardiographic monitoring. J Am Co11 Cardiol 2:798, 1983. Pratt CM, Francis MJ, Luck JC, Wyndham CR, Miller RR, Quinones MA: Analysis of ambulatory electrocardiogram in 15 patients during spontaneous ventricular fibrillations with special reference to preceding arrhythmic events. J Am Co11 Cardiol 2:789, 1983. Lewis BH, Antman EM, Graboys TB: Detailed analysis of 24 hour ambulatory electrocardiographic recordings during ventricular fibrillation or torsade de pointes. J Am Co11 Cardiol 2/3:426, 1983. Lie KI, Liem KL, Schuilenburg RM, David GK, Durrer D: Early identification of patients developing late in-hospital ventricular fibrillation after discharge from the coronary care unit. Am J Cardiol 41:674, 1978. Bigger JT, Heller CA, Wenger TL, Weld FM: Risk stratification after acute myocardial infarction. Am J Cardiol 42:202, 1978. Cats VM, Lie KI, Van Capelle FJL, Durrer D: Limitation of 24 hour ambulatory electrocardiographic recording in predicting coronary events after myocardial infarction. Am J Cardiol 44:1257, 1979. Schultze RA Jr, Strauss HW, Pitt B: Sudden death in the year following myocardial infarction: Relation to ventricular premature contraction in the late hospital phase and left ventricular ejection fraction. Am J Med 62:192, 1977. Clusin WT, Bristow MR, Kavsagneozian HS, Katzung MB, Schroeder JS: Do calcium dependent ionic currents mediate ischemic ventricular fibrillation? Am J Cardiol 49:606, 1982. Zipes DP, Gillmor RT: Calcium antagonists and their potential role in the prevention of sudden coronary death. In Greenberg HM, Dwyer M Jr, editors: Sudden coronary death. New York, 1982, Ann NY Acad Sci 362:258. Dunn RF, Newman HN, Bernstein L, Harris PJ, Tonbin GS, Corns J, Kelly DT: The clinical features of isolated left circumflex coronary artery disease. Circulation 69:477, 1984. Nademanee K, Hendrickson JA, Cannon DS, Goldreyer BN, Jing BN: Control of refractory life-threatening ventricular tachyarrhythmias by amiodarone. AM HEART J 101:7591, 1981. Hegger JJ, Pyrstowsky EN, Jackman WM, Naccarelli OV, Warfer KA, Rankenberger RL, Zipes DP: Amiodarone, clinical efficacy and electro-physiology during long-term therapy for recurrent ventricular tachycardia or ventricular fibrillation. N Engl J Med 305:539, 1981. McComb JM, Logan KR, Khan MM, Geddes JS, Adyey AM: Amiodarone-induced ventricular fibrillation. Eur J Cardiol 11:381, 1980. Sclarovsky S, Lewin RF, Krakoff 0, Strassberg B, Arditti A, Agmon J: Amiodarone-induced polymorphous ventricular tachycardia. AM HEART J 1056, 1983.

Exercise stress testing in the post-myocardial infarction patient

Recent studies indicate that predischarge evaluation of the post-myocardial infarction (MI) patient is important in predicting their subsequent course and the need for specific treatment. Left ventricular function, residual ischemia and the tendency toward ventricular arrhythmias can all be assessed noninvasively in the late hospital phase. Stress testing is 1 of the most useful and widely available of these techniques. An impaired hemodynamic response to exercise expressed by excessive tachycardia, plateau or falling blood pressure or reduced work load capacity suggests an increased risk of recurrent cardiac events in the near future. Angina or electrocardiographic abnormalities, including arrhythmias, also indicate a less favorable outcome. A good performance in a post-MI stress test is associated with a relatively good prognosis. The exercise electrocardiogram, therefore, appears to be a useful screening device for evaluating post-MI patients. Other noninvasive tests such as radionuclide ventriculography, exercise thallium scanning, Holter monitoring and echocardiography greatly augment the predictive value of exercise electrocardiography, and a patient profile should be developed using all the available clinical and laboratory data. Patients with a poor prognostic profile may then undergo further testing, such as coronary angiography, and their subsequent therapy modified appropriately.

Sudden cardiac death: role of left ventricular dysfunction.

Early studies from the Coronary Drug Project of sudden cardiac death in patients surviving an episode of myocardial infarction called attention to the importance of ventricular ectopic beats.' In that study, complex ventricular ectopic beats recorded on a 12-hour Holter electrocardiogram were found to be associated with an excessive risk of sudden cardiac death. When the relationship was examined between complex ventricular ectopic beats and other risk factors, such as age, number of prior infarctions, angina pectoris, hypertension, serum cholesterol, glucose intolerance, cardiomegaly seen on chest X-ray films, and cigarette-smoking, complex ventricular ectopic beats were found to be independent risk factors with respect to sudden cardiac death. The importance of ventricular ectopic beats as a predictor of sudden cardiac death during the convalescent or late hospital phase of acute myocardial infarction in this and other studies has led to the use of prophylactic antiarrhythmic therapy in an attempt to prevent or reduce these ectopic beats and hence to prevent sudden cardiac death. In a subsequent study by Schulze et al. patients surviving an episode of acute myocardial infarction underwent 24-hour Holter electrocardiographic recording and gated radionuclide left ventricular angiography prior to discharge from the hospital.? Several important findings emerged from this study: It was noted that 26 of 29 (90%) patients with complex ventricular arrhythmias (Lown Class 111-V) on Holter electrocardiographic recording had a left ventricular ejection fraction of <40% compared with only 19 of 52 (37%) without complex ventricular arrhythmias. During a mean follow-up period of 7 months, eight patients had documented ventricular fibrillation. All eight patients who suffered sudden death were in the subset of patients with complex late hospital phase ventricular arrhythmias and a left ventricular ejection fraction of <40%. This study was one of the first to call attention to the role of ventricular dysfunction in patients with sudden cardiac death after an episode of acute myocardial infarction. The failure of left ventricular dysfunction to be recognized as an important predictor of sudden death after myocardial infarction in the Coronary Drug Project and in other previous studies may be related to the use of the cardiothoracic (CT) ratio on chest X-ray film as an index of left ventricular function. Subsequent studies have pointed out that the CT ratio is a poor index of left ventricular function and that the correlation between the CT ratio and left ventricular ejection fraction is poor. Schulze et al. also found that the left ventricular ejection fraction and the percent of left ventricular akinesia on gated blood pool imaging were significantly better predictors of subsequent sudden cardiac death than was peak creatine phosphokinase (CPK) determined during the episode of acute infarction. Patients who subsequently died suddenly had

Reliability of serial 24 h ambulatory electrocardiography in predicting cardiac death after myocardial infarction.

One hundred consecutive patients below the age of 70 years, surviving an acute myocardial infarction, were subjected to 24-h electrocardiographic monitoring during the late hospital phase, as well as at one, three and six months after the infarction. Complex ventricular arrhythmias (multiform, couplets, R on T, ventricular tachycardia) were found in 34, 51, 41 and 39% of the patients on the four occasions, respectively. Thus a significant increase was found in relation to discharge (34 v. 51%, P <0.05). The cumulative percentage of patients with complex arrhythmias was 34, 65, 74 and 79% respectively, indicating a considerable intra-individual variation from time to time. Complex ventricular arrhythmias were found in only six patients during all monitorings. A close correlation between the quantitative and qualitative arrhythmia pattern was demonstrated. Nineteen cases of cardiac death occurred during an average follow-up period of 30 (range 27–34) months. During the late hospital phase, but not afterwards, complex ventricular arrhythmias were significantly more frequent in patients who subsequently had cardiac death (P <0.05). In 11 patients who had cardiac death, their final monitoring was without complex ventricular arrhythmias. As these arrhythmias were demonstrated in the large majority of patients and showed a considerable variation from time to time in the individual patient, even serial 24 h ambulatory electrocardiography has severe limitations in identifying well-defined high or low risk groups after myocardial infarction.

Prevalence, characteristics and significance of ventricular tachycardia (three or more complexes) detected with ambulatory electrocardiographic recording in the late hospital phase of acute myocardial infarction

A 24 hour electrocardiographic recording was performed before hospital discharge in 430 patients who survived the cardiac care unit phase of acute myocardial infarction. Fifty patients (11.6 percent) had ventricular tachycardia, that is, three or more consecutive ventricular complexes. In 25 (50 percent) of these 50 patients, there was only one episode of ventricular tachycardia and, in 15 patients (30 percent), the longest run of ventricular tachycardia was only three consecutive ventricular premature depolarizations. The average rate of tachycardia was 119/min. Tachycardia rarely started with R on T ventricular premature complexes (4 of 1,370 episodes in 50 patients). There was no difference between the groups with and without ventricular tachycardia with respect to age and sex, but the patients with tachycardia had a significantly greater prevalence of previous myocardial infarction, left ventricular failure in the cardiac care unit, atrial fibrillation, ventricular tachycardia or ventricular fibrillation in the cardiac care unit and significantly more frequent use of digitalis and diuretic and antiarrhythmic drugs at the time of hospital discharge. The group with tachycardia had a 38.0 percent 1 year mortality rate compared with the rate of 11.6 percent in the group without tachycardia. Ventricular tachycardia had a strong association with 1 year mortality (odds ratio = 4.7). Although ventricular tachycardia had a significant association with many other postinfarction risk factors, it was still significantly associated with the 1 year mortality (p < 0.05) when other important risk variables were controlled statistically using a multiple logistic regression model. The 36 month cumulative mortality rate was 54.0 percent in the group with ventricular tachycardia compared with 19.4 percent in the group without tachycardia.

Prevalence and significance of ventricular tachycardia in the late hospital phase of myocardial infarction

Prevalence and significance of ventricular tachycardia in the late hospital phase of myocardial infarction

QT interval in relation to ventricular arrhythmias and sudden cardiac death in postmyocardial infarction patients.

Ninety-one consecutive patients below the age of 70 years were subjected to a 60-second resting ECG and 24-hour ambulatory ECG monitoring two weeks and one, three and six months after an acute myocardial infarction. The corrected QT (QTc) interval decreased from the late hospital phase to the investigations three and six months after the infarction (p less than 0.01, less than 0.05). ECG monitorings showing complicated ventricular ectopic beats (multiform, repetitive, R-on-T) were associated with an insignificantly longer QTc than other recordings. Eleven patients suffered a sudden cardiac death during a median follow-up period of 24 months (range 22-27). The QTc intervals in patients who died suddenly were insignificantly longer than in the survivors. Only four patients, who all survived, had a constantly prolonged QTc. After exclusion of tracings during quinidine therapy, a QTc longer than 440 msec was found in 7 (23%) of 31 recordings from patients who suffered a sudden cardiac death compared to 29 (10%) of 287 recordings from the survivors (p less than 0.05). A combination of complicated ventricular ectopic beats and a QT longer than 440 msec was demonstrated in 5 (16%) of 31 and 14 (5%) of 287 recordings from the two groups of patients (p less than 0.05). A trend towards longer QTc intervals was observed in patients with complicated ventricular arrhythmias and in those who died suddenly, but no well defined high-risk groups could be identified.

Cardiovascular Diseases: An Annotated Bibliography of Recent Literature

Cardiovascular Diseases: An Annotated Bibliography of Recent Literature