Relationship between signal-averaged electrocardiography and dangerous ventricular arrhythmias in patients with left ventricular aneurysm after myocardial infarction

We performed signal-averaged electrocardiography (SAECG) andHolter monitoring, and subsequently followed-up 53 ambulatorypatients with left ventricular aneurysm (LVA) after myocardialinfarction (MI). A history of spontaneous episodes of sustainedventricular tachycardia (VT) v also analysed. Out of 53 patients, 25 (47%) had an abnormal SAECG. AbnormalSAECG correctly identified nine out of 10 cases with a historyof sustained VT. Complex ventricular arrhythmias were detectedon Holler monitoring in 23 patients: in five out of 28 withnormal SAECG (18%) and in 18 out of 25 with abnormal SAECG (72%)(P<0001). During follow-up (mean 19 months) sustained VTand/or sudden cardiac death (SCD) occurred in eight cases, outof which seven had an abnormal SAECG. The negative predictivevalue of SAECG (no VT or SCD during follow-up) was very high,96%. similar to the negative predictive value of a history ofsustained VT (93%). Using multivariate analysis only a historyof sustained VT twas an independent factor in predicting theoutcome of patients in this study. We conclude that an abnormal SAECG identifies those post infarctionpatients with LVA who are prone to complex ventricular arrhvthmias.A normal SAECG and an absence of a history of sustained VT stronglyindicate that the risk of developing arrhythmic events is verylow.