Role of electrophysiologic testing after MI

S. Jalal, Gerald Naccarelli, H. T. Shih, A. H. Dougherty

Research output: Contribution to journalReview articlepeer-review


Clinical trials of the prognostic value of electrophysiologic study (EPS) in survivors of myocardial infarction (MI) have had conflicting results. Differences in the definition of arrhythmia induction, types of patients selected for EPS, timing of EPS, and the protocols for programmed ventricular stimulation may account for these varying results. Induction of sustained ventricular tachycardia on EPS is a sensitive and specific predictor of subsequent ventricular arrhythmias in post-MI patients. However, comparable prognostic information can be obtained from such noninvasive findings as a low ejection fraction, the presence of frequent ectopy on Holter monitoring or of late potentials on signal-averaged ECG, and decreased heart rate variability, especially when such findings occur in combination. Electrophysiologic testing should not be used routinely to assess risk and guide management in MI survivors. Rather, all post-MI patients should be stratified for risk with noninvasive tests. In patients determined to be at high risk on the basis of these tests, the use of EPS should be considered, although the potential benefit of EPS-guided antiarrhythmic therapy on outcome has yet to be established. Patients who spontaneously develop sustained VT more than 48 hours post-MI are at high risk of a future arrhythmic event; some data suggest that aggressive EPS-guided therapy may improve survival in this subgroup.

Original languageEnglish (US)
Pages (from-to)30-40
Number of pages11
JournalJournal of Myocardial Ischemia
Issue number2
StatePublished - 1994

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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