Prognostic Significance of the Lown Grades and Late Potentials in Patients after Myocardial Infarction

다국어 초록 (Multilingual Abstract)

Background and Objectives: The aims of this study were to assess the long term overall survival of patients after an acute myocardial infarction (AMI), and to determine the association of survival with the occurrence of ventricular arrhythmia, as recorded by Holter electrocardiography (ECG) and signal-averaged electrocardiography (SAECG). Subjects and Methods: One hundred fifty two patients with an AMI were enrolled between January 2000 and August 2006. SAECG and Holter ECG were performed before hospital discharge (at range of 2-10 day). The grading system of Lown was used to evaluate the ventricular premature beats on Holter ECG. Three groups of patients were identified based on the seriousness of the ventricular arrhythmia, as identified by the Holter ECG: Lown grade 0, Lown grades 1, 2 and Lown grades 3, 4, 5. SAECG was performed with a high pass frequency of 25 Hz and 40 Hz. The presence of late potentials (LPs) recorded on SAECG was evaluated. The predictors for survival were assessed using Cox's proportional hazard model and Kaplan-Meier analysis. Results: The mean duration of follow-up was 45.8±25.5 months. Twenty four patients (15.8%) died during follow-up. The multivariate predictors of all cause death included age [hazard ratio (HR)=1.25, 95% confidence interval (CI)=1.08-1.47, p=0.003] and Lown grades 3, 4 and 5 (HR=19.17, 95% CI=1.25-290.80, p=0.034). Survival analysis did not show a significant relationship between LPs and overall patient survival. The only predictors for overall mortality were age and the Lown grade. Conclusion: SAECG did not predict mortality for the patient with AMI. The ventricular arrhythmias recorded by conventional Holter before hospital discharge may be a useful noninvasive prognostic test after an AMI. (Korean Circ J 2008;38:17-22)

참고문헌 (Reference)

1 손장원, "한국인 심근경색 환자에서 심장 돌연사를 예측하기 위한비침습적인 위험예측인자에 대한 고찰:" 대한심장학회 36 (36): 431-436, 2006

2 신동구, "급성 심장사의 위험도 예측을 위한 방법 및 문제점" 대한심장학회 32 (32): 637-645, 2002

3 Breithardt, G., "The signal-averaged ECG: time-domain analysis" 14 (14): 27-32, 1993

4 Bigger, J.T. Jr., "The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction" 69 : 250-258, 1984

5 Spear, J.F., "The effects of premature stimulation of His bundle on epicardial activation and body surface late potentials in dogs susceptible to sustained ventricular tachyarrhythmias" 72 : 214-224, 1985

6 Huikuri, H.V., "Sudden death due to cardiac arrhythmias" 345 : 1473-1482, 2001

7 Abildstrom, S.Z., "Sudden cardiovascular death following myocardial infarction: the importance of left ventricular systolic dysfunction and congestive heart failure" 104 : 184-189, 2005

8 Breithardt, G., "Standards for analysis of ventricular late potentials using high-resolution signal-averaged electrocardiography" 17 : 999-1006, 1991

9 Moon, S.J., "Signal averaged electrocardiography using holter tape in patients without heart disease" 27 : 42-48, 1997

10 el-Sherif, N., "Risk stratification and management of sudden cardiac death: a new paradigm" 14 : 1113-1119, 2003

11 Breithardt, G., "Recent advances in the identification of patients at risk of ventricular tachyarrhythmias: a role of ventricular late potentials" 75 : 1091-1096, 1987

12 Gomes, J.A., "Quantitative analysis of the high-frequency components of the signal-averaged QRS complex in patients with acute myocardial infarction: a prospective study" 72 : 105-111, 1985

13 Dennis, A.R., "Prognostic significance of ventricular tachycardia and fibrillation induced at programmed stimulation and delayed potentials detected on the signal-averaged electrocardiograms of survivors of acute myocardial infarction" 74 : 731-745, 1986

14 Breithardt, G., "Prognostic significance of late ventricular potentials after acute myocardial infarction" 4 : 487-495, 1983

15 Hohnloser, S.H., "Prevalence, characteristics and prognostic value during long-term follow-up of nonsustained ventricular tachycardia after myocardial infarction in the thrombolytic era" 33 : 1895-1902, 1999

16 Maggioni, A.P., "Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era" 87 : 312-322, 1993

17 Huikuri, H.V., "Prediction of sudden cardiac death: appraisal of the studies and methods assessing the risk of sudden arrhythmic death" 108 : 110-115, 2003

18 Makikallio, T.H., "Prediction of sudden cardiac death after acute myocardial infarction: role of Holter monitoring in the modern treatment era" 26 : 762-769, 2005

19 Simson, M.B., "Noninvasive identification of patients at high risk for sudden cardiac death: signal-averaged electrocardiography" 85 : 1145-1151, 1992

20 Kuchar, D.L., "Late potentials detected after myocardial infarction: natural history and prognostic significance" 74 : 1280-1289, 1986

21 Kontoyannis, D., "Late potential and late potentialindex during thrombolysis as markers of successful thrombolysis" 33 : 201-209, 1992

22 Garder, P.I., "Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts" 72 : 596-611, 1985

23 Cardner, P.I., "Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts" 72 : 596-611, 1985

24 el-Sherif, N., "Electrode catheter recording during malignant ventricular arrhythmia following experimental acute myocardial ischemia: evidence for re-entry due to conduction delay and block in ischemic myocardium" 51 : 1003-1014, 1975

25 Boehrer, J.D., "Effect of coronary angioplasty on late potentials one to two weeks after acute myocardial infarction" 70 : 1515-1519, 1992

26 Simson, M.B., "Detection of delayed ventricular activation on the body surface in dogs" 241 : H363-H369, 1981

27 Gang, E.S., "Decreased incidence of ventricular late potentials after successful thrombolytic therapy for acute myocardial infarction" 321 : 712-716, 1989

28 Kozer, L.M., "Clinical significance of variability of ventricular late potentials detected before discharge in patients after myocardial infarction" 139 : 134-141, 2000

29 Lown, B., "Approaches to sudden death from coronary heart disease" 44 : 130-142, 1971