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Prediction of sudden arrhythmic death following acute myocardial infarction
  1. Reginald Liew1,2
  1. 1National Heart Centre Singapore, Department of Cardiology, Singapore
  2. 2Duke-NUS Graduate Medical School, Singapore
  1. Correspondence to Dr Reginald Liew, Consultant Cardiologist, National Heart Centre Singapore, 17 Third Hospital Avenue, Singapore 168752, Singapore; reginald.liew.k.c{at}nhc.com.sg

Abstract

Many patients who survive an acute myocardial infarction (AMI) remain at risk of sudden cardiac death despite optimal medical treatment. AMI survivors are currently risk assessed and selected for implantable cardioverter defibrillator (ICD) insertion mainly on the basis of their left ventricular ejection fraction. Several other cardiovascular tests are available that can detect the myocardial substrate abnormalities and help refine risk. These investigations include ECG-based tests (signal averaged ECG and T-wave alternans), Holter-based recordings (heart rate variability and heart rate turbulence) and imaging techniques (cardiac magnetic resonance). Recent evidence also points towards a potential role for other indices on the 12-lead ECG and genetic profiling in risk prediction. This study reviews the current evidence for the use of these tests in AMI survivors and addresses their pros and cons in guiding the selection of ICD recipients.

  • Acute myocardial infarction
  • sudden cardiac death
  • risk prediction
  • ventricular arrhythmias
  • ventricular fibrillation
  • ventricular tachycardia
  • risk stratification

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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