pós-infarto agudo do miocárdio (IAM) têm mostrado baixo valor preditivo positivo quando estudados isoladamente. A possibilidade da Eletrocardiografia Dinâmica de 24 horas (ECGD) fornecer dados referentes a isquemia silenciosa (IS), arritmias ventriculares e modulação autonômica do coração pelo estudo da variabilidade da freqüência cardíaca (VFC), levou o autor a empregar este método em pacientes acometidos de IAM com o objetivo de avaliar se estas três variáveis estariam relacionadas a presença de eventos desfavoráveis em evolução a médio prazo. Material e Métodos – Foram selecionados 91 pacientes acometidos de um primeiro IAM não-complicado e realizados exames de ECGD de 24 h por dois dias consecutivos, antes da alta hospitalar. Os parâmetros pesquisados nos exames foram: isquemia silenciosa, identificação e quantificação de arritmias ventriculares e determinação dos índices de VFC pelos métodos do domínio do tempo e do mapa de retorno tridimensional. Foram considerados como desfechos: re-infarto, angina instável, taquicardia ventricular sustentada e morte. Resultados – No seguimento médio de 27,7 meses (DP=15,45), 23 (25%) dos pacientes apresentaram eventos, sendo nove fatais. Os eventos foram mais freqüentes entre os pacientes que apresentaram extra-sístoles ventriculares ≥10/hora (p=0,01) e também naqueles com IS (p=0,02). Em modelo de análise multifatorial, a presença de dislipidemia elevou o valor preditivo positivo dessas variáveis. Nenhum dos índices de VFC esteve significativamente relacionado ao surgimento de eventos. Conclusões – Em pacientes pós-IAM de baixo risco, a presença de arritmias ventriculares freqüentes ou de isquemia silenciosa está relacionada a um prognóstico desfavorável. O estudo da VFC não mostrou utilidade na estratificação de risco destes pacientes. / Introduction and objective – The noninvasive methods used in post-acute myocardial infarction (AMI) risk stratification have been shown to have a low predictive value when studied in isolation. The possibility that ambulatory electrocardiographic monitoring (AEM) may provide data on silent ischemia (SI), ventricular arrhythmias (VA) and autonomic modulation of the heart through the study of heart rate variability (HRV) led the present author to use this method in AMI patients with the aim of assessing whether these three variables could be related to the presence of unfavorable events in the medium term follow-up. Methods – Ninety-one patients with a first, uncomplicated AMI were selected and submitted to AEM for two consecutive days prior to discharge from the hospital. The parameters studied in the examination were as follows: presence of SI, identification and quantification of VA and determination of the HRV indices by the time domain and three-dimensional return map methods. The following were regarded as outcomes: new AMI, unstable angina, sustained ventricular tachycardia and death. Results – In the mean follow-up of 27.7 months (SD=15.45), 23 (25%) of the patients presented events, nine of which were fatal. Events occurred most frequently in the patients who presented ventricular premature contractions >= (p=0.01) and also in those with SI (p=0.04). In the multifactorial analysis the presence of dislipidemia raised the positive predictive value of these variables. None of the HRV indices was significantly correlated with the occurrence of events. Conclusions – In low-risk post-AMI patients the presence of frequent ventricular arrhythmias or silent ischemia is associated with an unfavorable prognosis. The study of HRV was not shown to be useful in the risk stratification of these patients.

pós-infarto agudo do miocárdio (IAM) têm mostrado baixo valor preditivo positivo quando estudados isoladamente. A possibilidade da Eletrocardiografia Dinâmica de 24 horas (ECGD) fornecer dados referentes a isquemia silenciosa (IS), arritmias ventriculares e modulação autonômica do coração pelo estudo da variabilidade da freqüência cardíaca (VFC), levou o autor a empregar este método em pacientes acometidos de IAM com o objetivo de avaliar se estas três variáveis estariam relacionadas a presença de eventos desfavoráveis em evolução a médio prazo. Material e Métodos – Foram selecionados 91 pacientes acometidos de um primeiro IAM não-complicado e realizados exames de ECGD de 24 h por dois dias consecutivos, antes da alta hospitalar. Os parâmetros pesquisados nos exames foram: isquemia silenciosa, identificação e quantificação de arritmias ventriculares e determinação dos índices de VFC pelos métodos do domínio do tempo e do mapa de retorno tridimensional. Foram considerados como desfechos: re-infarto, angina instável, taquicardia ventricular sustentada e morte. Resultados – No seguimento médio de 27,7 meses (DP=15,45), 23 (25%) dos pacientes apresentaram eventos, sendo nove fatais. Os eventos foram mais freqüentes entre os pacientes que apresentaram extra-sístoles ventriculares ≥10/hora (p=0,01) e também naqueles com IS (p=0,02). Em modelo de análise multifatorial, a presença de dislipidemia elevou o valor preditivo positivo dessas variáveis. Nenhum dos índices de VFC esteve significativamente relacionado ao surgimento de eventos. Conclusões – Em pacientes pós-IAM de baixo risco, a presença de arritmias ventriculares freqüentes ou de isquemia silenciosa está relacionada a um prognóstico desfavorável. O estudo da VFC não mostrou utilidade na estratificação de risco destes pacientes. / Introduction and objective – The noninvasive methods used in post-acute myocardial infarction (AMI) risk stratification have been shown to have a low predictive value when studied in isolation. The possibility that ambulatory electrocardiographic monitoring (AEM) may provide data on silent ischemia (SI), ventricular arrhythmias (VA) and autonomic modulation of the heart through the study of heart rate variability (HRV) led the present author to use this method in AMI patients with the aim of assessing whether these three variables could be related to the presence of unfavorable events in the medium term follow-up. Methods – Ninety-one patients with a first, uncomplicated AMI were selected and submitted to AEM for two consecutive days prior to discharge from the hospital. The parameters studied in the examination were as follows: presence of SI, identification and quantification of VA and determination of the HRV indices by the time domain and three-dimensional return map methods. The following were regarded as outcomes: new AMI, unstable angina, sustained ventricular tachycardia and death. Results – In the mean follow-up of 27.7 months (SD=15.45), 23 (25%) of the patients presented events, nine of which were fatal. Events occurred most frequently in the patients who presented ventricular premature contractions >= (p=0.01) and also in those with SI (p=0.04). In the multifactorial analysis the presence of dislipidemia raised the positive predictive value of these variables. None of the HRV indices was significantly correlated with the occurrence of events. Conclusions – In low-risk post-AMI patients the presence of frequent ventricular arrhythmias or silent ischemia is associated with an unfavorable prognosis. The study of HRV was not shown to be useful in the risk stratification of these patients.

pós-infarto agudo do miocárdio (IAM) têm mostrado baixo valor preditivo positivo quando estudados isoladamente. A possibilidade da Eletrocardiografia Dinâmica de 24 horas (ECGD) fornecer dados referentes a isquemia silenciosa (IS), arritmias ventriculares e modulação autonômica do coração pelo estudo da variabilidade da freqüência cardíaca (VFC), levou o autor a empregar este método em pacientes acometidos de IAM com o objetivo de avaliar se estas três variáveis estariam relacionadas a presença de eventos desfavoráveis em evolução a médio prazo. Material e Métodos – Foram selecionados 91 pacientes acometidos de um primeiro IAM não-complicado e realizados exames de ECGD de 24 h por dois dias consecutivos, antes da alta hospitalar. Os parâmetros pesquisados nos exames foram: isquemia silenciosa, identificação e quantificação de arritmias ventriculares e determinação dos índices de VFC pelos métodos do domínio do tempo e do mapa de retorno tridimensional. Foram considerados como desfechos: re-infarto, angina instável, taquicardia ventricular sustentada e morte. Resultados – No seguimento médio de 27,7 meses (DP=15,45), 23 (25%) dos pacientes apresentaram eventos, sendo nove fatais. Os eventos foram mais freqüentes entre os pacientes que apresentaram extra-sístoles ventriculares ≥10/hora (p=0,01) e também naqueles com IS (p=0,02). Em modelo de análise multifatorial, a presença de dislipidemia elevou o valor preditivo positivo dessas variáveis. Nenhum dos índices de VFC esteve significativamente relacionado ao surgimento de eventos. Conclusões – Em pacientes pós-IAM de baixo risco, a presença de arritmias ventriculares freqüentes ou de isquemia silenciosa está relacionada a um prognóstico desfavorável. O estudo da VFC não mostrou utilidade na estratificação de risco destes pacientes. / Introduction and objective – The noninvasive methods used in post-acute myocardial infarction (AMI) risk stratification have been shown to have a low predictive value when studied in isolation. The possibility that ambulatory electrocardiographic monitoring (AEM) may provide data on silent ischemia (SI), ventricular arrhythmias (VA) and autonomic modulation of the heart through the study of heart rate variability (HRV) led the present author to use this method in AMI patients with the aim of assessing whether these three variables could be related to the presence of unfavorable events in the medium term follow-up. Methods – Ninety-one patients with a first, uncomplicated AMI were selected and submitted to AEM for two consecutive days prior to discharge from the hospital. The parameters studied in the examination were as follows: presence of SI, identification and quantification of VA and determination of the HRV indices by the time domain and three-dimensional return map methods. The following were regarded as outcomes: new AMI, unstable angina, sustained ventricular tachycardia and death. Results – In the mean follow-up of 27.7 months (SD=15.45), 23 (25%) of the patients presented events, nine of which were fatal. Events occurred most frequently in the patients who presented ventricular premature contractions >= (p=0.01) and also in those with SI (p=0.04). In the multifactorial analysis the presence of dislipidemia raised the positive predictive value of these variables. None of the HRV indices was significantly correlated with the occurrence of events. Conclusions – In low-risk post-AMI patients the presence of frequent ventricular arrhythmias or silent ischemia is associated with an unfavorable prognosis. The study of HRV was not shown to be useful in the risk stratification of these patients.

Identifying factors associated with appropriate and inappropriate therapies in patients with implantable cardioverter-defibrillator (ICD) could help to identify those at risk and reduce the incidence of this emergency situation which has detrimental effect on mortality and morbidity in patients with ICD. These studies were designed to find the prevalence and factors associated with appropriate and inappropriate therapies in patients with ICD.

Introduction: Ventricular arrhythmias (VAs) are common after an acute coronary syndrome (ACS) and are associated with worse clinical outcomes. However, little is known about recent trends in their occurrence, their association with serum glucose levels, and their psychological impact in ACS setting. Methods: We examined 25-year (1986-2011) trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of VAs, and the association between serum glucose levels and VAs in patients with an acute myocardial infarction (AMI) in the Worcester Heart Attack Study. Lastly, we examined the relationship between in-hospital occurrence of VAs and 12-month progression of depression and anxiety among hospital survivors of an ACS in the longitudinal TRACE-CORE study. Results: We found the IRs declined for several major VAs between 1986 and 2011while the hospital CFRs declined in both patients with and without VAs over this period. Elevated serum glucose levels at hospital admission were associated with a higher risk of developing in-hospital VAs. Occurrence of VAs, however, was not associated with worsening progression of symptoms of depression and/or anxiety over a 12-month follow-up period in patients discharged after an ACS. Conclusions: The burden and impact of VAs in patients with an AMI has declined over time. Elevated serum glucose levels at hospital admission may serve as a predictor for in-hospital occurrence of serious cardiac arrhythmias. In-hospital occurrence of VAs may not be associated with worsening progression of symptoms of depression and anxiety in patients with an ACS.