RISK OF VENTRICULAR ARRHYTHMIAS IN SURVIVORS OF MYOCARDIAL-INFARCTION

The most recent studies have made it clear that the prognosis of asymp tomatic post-MI patients has significantly improved in the last two de cades. Holter monitoring as well as a low LVEF still is an important m ethod for the risk stratification in the thrombolytic era of patients with post-MI. Patients with normal noninvasive tests do have a good pr ognosis. The electrophysiological stimulation seems to be the clinical ly most valuable single method to predict arrhythmic events. However, as an invasive procedure it is not suitable as a screening test for a large cohort. The stepwise risk stratification technique using first n oninvasive followed by inversive procedures seem to be most suitable a nd effective for identifying asymptomatic infarct survivors which inci dence of arrhythmic events is as high as the recurrence rate of patien ts who had been resuscitated from ventricular fibrillation. Consequent ly, prophylactic implantation of a defibrillator in asymptomatic MI pa tients, whose positive predictive value is around 30% becomes more and more interesting.