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The predictive accuracy of time-domain (TD) late potential analysis of the signal-averaged electrocardiogram in postmyocardial infarction (MI) is limited by the high incidence of false positives in inferior MI. However, frequency-domain spectral turbulence (ST) analysis suffers from a high incidence of false positives, especially in anterior MI. A prospective study was conducted of 262 patients with acute MI to investigate the hypothesis that combined TD and ST analyses of the signal-averaged electrocardiogram could improve its predictive accuracy for serious arrhythmic events in the post-MI period. Abnormal TD criteria were RMS40 less than 25 μV at 25 Hz plus RMS40 less than 16 μV at 40 Hz, and abnormal ST criteria were a turbulence score of 3 or 4. Seventeen patients had arrhythmic events during 10.5 ± 2.4 months of follow-up evaluation (13 sudden cardiac death judged to be due to arrhythmia and 4 nonfatal …