Prediction of sudden arrhythmic death following acute myocardial infarction

Many patients who survive an acute myocardial infarction (AMI) remain at risk of sudden cardiac death despite optimal medical treatment. AMI survivors are currently risk assessed and selected for implantable cardioverter defibrillator (ICD) insertion mainly on the basis of their left ventricular ejection fraction. Several other cardiovascular tests are available that can detect the myocardial substrate abnormalities and help refine risk. These investigations include ECG-based tests (signal averaged ECG and T-wave alternans), Holter-based recordings (heart rate variability and heart rate turbulence) and imaging techniques (cardiac magnetic resonance). Recent evidence also points towards a potential role for other indices on the 12-lead ECG and genetic profiling in risk prediction. This study reviews the current evidence for the use of these tests in AMI survivors and addresses their pros and cons in guiding the selection of ICD recipients.