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Bastiaenen R, Batchvarov V, Gallagher MM. Ventricular automaticity as a predictor of sudden death in ischaemic heart disease. Europace 2011; 14:795-803. [DOI: 10.1093/europace/eur342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Simpson RJ, Cascio WE, Crow RS, Schreiner PJ, Rautaharju PM, Heiss G. Association of ventricular premature complexes with electrocardiographic-estimated left ventricular mass in a population of African-American and white men and women (The Atherosclerosis Risk in Communities. Am J Cardiol 2001; 87:49-53. [PMID: 11137833 DOI: 10.1016/s0002-9149(00)01271-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Increased left ventricular (LV) mass is often found in adults and is a powerful predictor of cardiovascular mortality. To test the hypothesis that an electrocardiographic estimate of LV mass--the Cornell voltage--is associated with ventricular premature complexes (VPCs) in free-living adults, a cross-sectional analysis of the predictors of VPCs on a 2-minute rhythm strip in a population-based sample of 13,606 middle-aged, African-American and white men and women from 4 US communities in the Atherosclerosis Risk in Communities Study baseline examinations was performed. In adults without known coronary artery disease, the prevalence of VPCs increases monotonically with increasd Cornell voltages within ethnicity and gender groups. Independent of systemic hypertension, serum electrolytes, age, heart rate, educational attainment, gender, and ethnicity, a millivolt increase in Cornell voltage was associated with a 20% to 30% increase in the prevalence odds ratio of VPCs on the 2-minute electrocardiogram. Thus, Cornell voltage is associated with VPCs on a 2-minute electrocardiogram. The association is consistent in African-Americans, whites, men, and women.
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Affiliation(s)
- R J Simpson
- Department of Medicine, School of Medicine and School of Public Health, University of North Carolina at Chapel Hill 27599-7075, USA.
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Evenson KR, Welch VL, Cascio WE, Simpson RJ. Validation of a short rhythm strip compared to ambulatory ECG monitoring for ventricular ectopy. J Clin Epidemiol 2000; 53:491-7. [PMID: 10812321 DOI: 10.1016/s0895-4356(99)00190-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Premature ventricular contractions (PVCs) are associated with an increased risk of cardiovascular disease and mortality. Many epidemiologic studies measure a continuous short rhythm strip to ascertain PVCs as a screening tool to identify persons at highest risk. Despite its widespread use in epidemiologic studies, the rhythm strip has not been completely validated. Therefore, a continuous 2-min rhythm strip was measured on 242 consecutive individuals referred for ambulatory ECG monitoring. Prevalence of at least one PVC on the 2-min rhythm strip was compared to a gold standard, the average number of PVCs per hr on ambulatory recording. The prevalence of any PVCs on the 2-min rhythm strip was 19%. As average PVCs per hr increased on the ambulatory ECG recording, sensitivity increased while specificity slowly decreased. Sensitivity ranged from 26-100% and specificity ranged from 81-100% across the distribution of average PVCs per hr on ambulatory monitoring. Area under the receiver operator characteristic (ROC) curve of the 2-min rhythm strip compared to 24-hr results was 0.943. Area under ROC curves were not statistically different (P > 0.05) by age, gender, hypertension status, or history of myocardial infarction. In this clinical population, utilizing the 2-min rhythm strip as an indicator of average PVCs per hr had excellent specificity and moderate to low sensitivity across most of the distribution of average PVCs per hr. The use of a short rhythm strip to detect PVCs may be considered useful in epidemiologic investigations of cardiovascular disease and mortality for detecting high frequency PVCs in populations. The use of a short rhythm strip as a screening tool to detect PVCs in clinical practice is not warranted, based on our findings and the existing literature. However, an awareness that PVCs on a 2-min rhythm strip consistently identify high frequency PVCs on 24-hr recordings should be helpful to clinicians.
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Affiliation(s)
- K R Evenson
- Department of Epidemiology, School of Public Health, University of North Carolina-Chapel Hill, 137 East Franklin Street, Bank of America Center, Suite 306, Chapel Hill, NC 27514, USA.
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Michaels AD, Goldschlager N. Risk stratification after acute myocardial infarction in the reperfusion era. Prog Cardiovasc Dis 2000; 42:273-309. [PMID: 10661780 DOI: 10.1053/pcad.2000.0420273] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Historically, risk stratification for survivors of acute myocardial infarction (AMI) has centered on 3 principles: assessment of left ventricular function, detection of residual myocardial ischemia, and estimation of the risk for sudden cardiac death. Although these factors still have important prognostic implications for these patients, our ability to predict adverse cardiac events has significantly improved over the last several years. Recent studies have identified powerful predictors of adverse cardiac events available from the patient history, physical examination, initial electrocardiogram, and blood testing early in the evaluation of patients with AMI. Numerous studies performed in patients receiving early reperfusion therapy with either thrombolysis or primary angioplasty have emphasized the importance of a patent infarct related artery for long-term survival. The predictive value of a variety of noninvasive and invasive tests to predict myocardial electrical instability have been under active investigation in patients receiving early reperfusion therapy. The current understanding of the clinically important predictors of clinical outcomes in survivors of AMI is reviewed in this article.
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Affiliation(s)
- A D Michaels
- Department of Medicine, University of California at San Francisco Medical Center, 94143-0124, USA.
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Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A, Green LA, Greene HL, Silka MJ, Stone PH, Tracy CM, Gibbons RJ, Alpert JS, Eagle KA, Gardner TJ, Gregoratos G, Russell RO, Ryan TH, Smith SC. ACC/AHA Guidelines for Ambulatory Electrocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). Developed in collaboration with the North American Society for Pacing and Electrophysiology. J Am Coll Cardiol 1999; 34:912-48. [PMID: 10483977 DOI: 10.1016/s0735-1097(99)00354-x] [Citation(s) in RCA: 189] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Affiliation(s)
- A J Camm
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, England, UK
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Petretta M, Bianchi V, Pulcino A, Carpinelli A, Valva G, Themistoclakis S, Attisano T, Salemme L, Bonaduce D. Continuous electrocardiographic monitoring for more than one hour does not improve the prognostic value of ventricular arrhythmias in survivors of first acute myocardial infarction. Am J Cardiol 1994; 73:139-42. [PMID: 7507637 DOI: 10.1016/0002-9149(94)90204-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study was designed to compare the prognostic value of predischarge ambulatory electrocardiographic monitoring for 1, 6 and 24 hours in 188 patients surviving a first acute myocardial infarction. Ventricular premature complexes (VPCs) were considered as a mean hourly rate or classified using Lown and Moss grading systems. During the 1-year follow-up 20 cardiac deaths occurred. For all 3 monitoring times, a higher number of VPCs/hour and a higher Moss grade were associated with mortality, whereas a Lown grading system gave prognostic information only for the first hour of recording. Monitoring time did not influence specificity or sensitivity in predicting mortality; > or = 3 VPCs/hour showed a higher sensitivity than > or = 10 VPCs/hour (p < 0.05) with a comparable specificity. After 1-hour data entered the model, neither the 6- or the 24-hour data entry improved the overall likelihood ratio statistic, regardless of what VPC grading system was used. These results demonstrate that continuous electrocardiographic recordings of > 1 hour are unnecessary when they are to be used for detecting ventricular arrhythmia as a predictor of mortality in patients surviving a first acute myocardial infarction.
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Affiliation(s)
- M Petretta
- Institute of Internal Medicine, Cardiology and Heart Surgery, University Federico II, Naples, Italy
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Ceremuzynski L, Kleczar E, Krzeminska-Pakula M, Kuch J, Nartowicz E, Smielak-Korombel J, Dyduszynski A, Maciejewicz J, Zaleska T, Lazarczyk-Kedzia E. Effect of amiodarone on mortality after myocardial infarction: a double-blind, placebo-controlled, pilot study. J Am Coll Cardiol 1992; 20:1056-62. [PMID: 1401602 DOI: 10.1016/0735-1097(92)90357-s] [Citation(s) in RCA: 226] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the effect of amiodarone on mortality, ventricular arrhythmias and clinical complications in high risk postinfarction patients. BACKGROUND No therapy has been shown to reduce sudden death in patients ineligible to receive beta-adrenergic blocking agents after myocardial infarction. METHODS Patients who were not eligible to receive beta-blockers were randomized to receive amiodarone (n = 305) or placebo (n = 308) for 1 year. RESULTS There were 21 deaths in the amiodarone group compared with 33 in the placebo group (odds ratio 0.62, 95% confidence interval [CI] 0.35 to 1.08, p = 0.095). There were two noncardiac deaths in the amiodarone group and none in the placebo group; thus, the difference in cardiac mortality (19 vs. 33, respectively) was statistically significant (odds ratio 0.55, 95% CI 0.32 to 0.99, p = 0.048). There was a significant decrease in Lown class 4 ventricular arrhythmias (7.5% vs. 19.7%, respectively, p < 0.001). Adverse effects developed in 30% of amiodarone-treated patients and 10% of placebo-treated patients. Pulmonary toxicity, which was mild and reversible, occurred in only one patient in the amiodarone group but in no patient in the placebo group. CONCLUSIONS This trial demonstrated a significant reduction in cardiac mortality and ventricular arrhythmias with amiodarone treatment. However, given the wide confidence intervals and borderline statistical significance of our trial, larger trials are needed to confirm or refute this view.
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Affiliation(s)
- L Ceremuzynski
- Department of Cardiology, Postgraduate Medical School, Warsaw, Poland
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Martínez-Useros C, Tornos P, Montoyo J, Permanyer Miralda G, Alijarde M, García del Castillo H, Moreno V, Soler-Soler J. Ventricular arrhythmias in aortic valve disease: a further marker of impaired left ventricular function. Int J Cardiol 1992; 34:49-56. [PMID: 1372301 DOI: 10.1016/0167-5273(92)90081-d] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
One hundred and twenty stable patients with pure and severe aortic valve disease and without coronary lesions (aortic stenosis, 43 patients; aortic regurgitation, 45 patients; combined aortic stenosis and regurgitation, 32 patients) who had been submitted to haemodynamic studies were prospectively studied with standard electrocardiograms, M-mode echocardiograms, and 24-hour ambulatory electrocardiography (Holter recording). The frequency and complexity of ventricular arrhythmias were related to clinical parameters such as functional class, type of lesion and presence of syncope, and to parameters of left ventricular hypertrophy and function. Ventricular arrhythmias were present in 92% of patients. A high number of ventricular premature beats was directly correlated with parameters of complexity of the arrhythmia. A significant relation was found between electrocardiographic left ventricular hypertrophy and Ryan class (P less than 0.05), and an inverse relation between maximal number of ventricular premature beats in any hour and left ventricular ejection fraction (P less than 0.05). The group of patients with aortic regurgitation showed a higher total number of ventricular premature beats per 24 hours (P less than 0.001), a higher maximal number of these in any hour (P less than 0.01), a higher number of patients with pairs (P less than 0.001), and a higher number of patients in Ryan classes 3, 4A, 4B (P less than 0.01). This study shows a high incidence of ventricular arrhythmias in aortic valve disease, and especially in aortic regurgitation, with a significant relation between left ventricular hypertrophy and function, and number and complexity of arrhythmias.
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Affiliation(s)
- C Martínez-Useros
- Departamento de Medicina, Hospital General Vall d'Hebron, Barcelona, Spain
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Connolly SJ, Cairns JA. Comparison of one-, six- and 24-hour ambulatory electrocardiographic monitoring for ventricular arrhythmia as a predictor of mortality in survivors of acute myocardial infarction. CAMIAT Pilot Study Group. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial. Am J Cardiol 1992; 69:308-13. [PMID: 1734640 DOI: 10.1016/0002-9149(92)90225-n] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To compare 1-, 6- and 24-hour ambulatory electrocardiograms for prediction of mortality after acute myocardial infarction (AMI), all patients with AMI hospitalized in Hamilton, Ontario during 1 year were identified. There were 683 patients discharged alive after AMI. One-, 6- and 24-hour ambulatory electrocardiographic results were available in 565 patients, and follow-up mortality data at 1 year was available in 560. Mean age of the patients was 64 years; 160 (29%) had previous AMI and 105 (19%) had had congestive heart failure. One hundred and fifty-two patients (27%) were receiving beta blockers, and 31 (6%) were receiving antiarrhythmic drugs. Regression modeling of survival times up to 1 year showed that all 3 durations of recording were univariate predictors of mortality. Using greater than 10 ventricular premature complexes/hour as the criterion of a positive test, neither the 6- nor 24-hour data contained statistically significant residual explanatory power after the 1-hour data were accounted for by the model. The longer durations of recording increased sensitivity at a cost of decreased specificity. The positive and negative predictive values of the 3 durations of recording were virtually identical. The presence of ventricular tachycardia was not a significant predictor of mortality in this population. There appears to be no benefit to ambulatory electrocardiographic recordings greater than 1 hour when they are to be used for prediction of 1-year mortality after AMI.
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Affiliation(s)
- S J Connolly
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
- K Nademanee
- Department of Cardiology, Denver General Hospital, CO 80204
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