Strategies to manage the post-MI patient with ventricular arrhythmias.

The occurrence of late ventricular arrhythmias after acute myocardial infarction is common. The available data do not support the treatment of asymptomatic premature ventricular complexes or asymptomatic non-sustained ventricular tachycardia after acute myocardial infarction. Signal-averaged electrocardiograms, perhaps in combination with Holter recording and measurements of left ventricular function show promise as potential markers of risk for subsequent sudden death or sustained ventricular tachycardia. Nevertheless, the appropriate treatment of any high-risk but asymptomatic subset of patients has not been established. Patients experiencing sustained ventricular tachycardia after acute myocardial infarction and survivors of late ventricular fibrillation are at high risk of early cardiac mortality and require aggressive treatment which may consist of serial electrophysiologic testing to evaluate drug therapy, arrhythmia surgery, or placement of an automatic implantable cardioverter defibrillator.