Should Electrophysiological Studies Be Performed in Asymptomatic Patients Following Myocardial Infarction? A Pragmatic Approach

We analyze the arguments commonly afforded by advocates of electrophysiological evaluation for patients with recent myocardial infarction. These argu ments are: (1) electrophysiological evaluation is useful for risk stratification of infarct survivors; and (2) it may be used for guiding drug therapy or to identify a group of asymptomatic patients who will benefit from implantation of an automatic cardioverter defibrillator. A positive electrophysiological study is ap parently the single best predictor of future arrhythmic events in infarct survivors. However, several nonin‐vasive tests combined may provide just as valuable information. Therefore, electrophysiological evalua tion should not be advised, to the majority of infarct survivors, for the mere purpose of risk stratification. Nevertheless, electrophysiological evaluation may be proposed to patients with impaired left ventricular function or high grade ventricular arrhythmias. Patients without inducible arrhythmias have a good prog nosis and may be spared the risk of long‐term treatment with antiarrhythmic drugs. However, before proceeding with invasive electrophysiological evaluation, both physician and patient should ask them selves if they are willing to go ahead with defibrillator implantation in case sustained monomorphic ventricular tachycardia is induced.