NON-INVASIVE MARKERS OF DISPERSION OF REPOLARIZATION, VENTRICULAR ARRHYTHMIAS AND ICD THERAPIES IN POST-MYOCARDIAL INFARCTION PATIENTS WITH RELATIVELY PRESERVED LEFT VENTRICULAR EJECTION FRACTION

Abstract Background Sustained ventricular arrhythmias (VAs) and death are feared events post myocardial infarction (post-MI). Patients with heart failure post-MI have higher risk of VAs, compared to those without heart failure. Although the risk of sudden cardiac arrest and death post-MI isn't small, previous clinical trials have failed to demonstrate the benefit of early use of implantable cardioverter defibrillators. Moreover, little is known about the relationship between the acute phase and the late phase VAs in patients with heart failure post-MI. Purpose The aim of this study was to determine the predictors of the late phase VAs in patients with heart failure post MI. Methods We retrospectively analyzed our database of MI patients from January 2012 to September 2016. Results A total of consecutive 460 post-MI patients were included in this study (age, 67±12 year-old; male, 336 (73%); STEMI, 281 (61%)). All the patients underwent primary percutaneous coronary intervention. Of those, 90 patients (20%) had depressed left ventricular ejection fraction (LVEF) ≤35%. After a mean follow up period of 30±16 months, 45 patients (50%) had VAs after MI. Among them, 35 patients (78%) had VAs within 48 hours after MI onset, 8 patients (18%) within 7 days 48 hours later, and 21 patients (47%) more than 7 days. Cox-regression analysis showed that VAs within 7 days 48 hours later after MI onset was significantly related to sustained VAs more than 7 days after MI onset (Hazard Ratio, 4.97; 95% Confidence Interval, 1.31–18.9; p=0.019). Conclusions VAs in the sub-acute phase after MI predicted sustained VAs in the late phase in this population. Prompt initiation of aggressive antiarrhythmic therapies, including catheter ablation, after MI should be considered to reduce the mortality.

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Late ventricular potentials in risk assessment of the occurrence of complex ventricular arrhythmia in patients with myocardial infarction and heart failure

Vojnosanitetski pregled ◽

10.2298/vsp0406589c ◽

2004 ◽

Vol 61 (6) ◽

pp. 589-597 ◽

Cited By ~ 1

Author(s):

Zoran Cosic ◽

Dragan Tavciovski ◽

Aleksandra Jovelic ◽

Radoslav Romanovic

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Ventricular Arrhythmias ◽

Left Ventricular ◽

Ventricular Ejection ◽

Tissue Type ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Aim. To determine the prognostic significance of late ventricular potentials on signal-averaged electrocardiogram and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmia in patients treated with accelerated tissue-type plasminogen activator, using the rapid protocol, within six months of acute myocardial infarction. Methods. In this analytic observational prospective study patients were divided into four groups: patients with left ventricular ejection fraction bellow 40% and late ventricular potentials, patients with left ventricular ejection fraction bellow 40% and without late ventricular potentials, patients with left ventricular ejection fraction over 40% and late ventricular potentials, and patients with left ventricular ejection fraction over 40% and without late ventricular potentials. Complex ventricular arrhythmias (Lown grade IVa, IVb, and V) were recorded using standard electrocardiography and 24-hour Holter monitoring 21, 60, and 90 days after acute myocardial infarction, respectively. Serial recordings of signal-averaged electrocardiogram were obtained 30, 90, and 180 days after acute myocardial infarction. Left ventricular ejection fraction was determined by echocardiography between 15 and 21 days after acute myocardial infarction. Multivariant logistic regression analysis was used to evaluate the relation between late ventricular potentials and left ventricular ejection fraction with the occurrence of complex ventricular arrhythmias. Sensitivity, specificity, positive and negative predictive values of late ventricular potentials and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmias were determined. Results. The prospective study included 80 patients (73% men), mean age 64 ? 3.5 years. Complex ventricular arrhythmias were recorded in 34 (42.5%) of patients, all 17 (50%) of which were from the first group (p<0.01). Complex ventricular arrhythmias were recorded in 25 (73.5%) patients with late ventricular potentials, and in 23 (67.6%) patients with left ventricular ejection fraction bellow 40%. Left ventricular ejection fraction bellow 40% and late ventricular potentials represented independent predictors for the occurrence of complex ventricular arrhythmias (RR=14.33, p<0.01). When combined with left ventricular ejection fraction bellow 40%, late ventricular potentials had sensitivity (0.50), specificity (0.93), and positive predictive accuracy (0.85) higher than late ventricular potentials alone (0.44, 0.67, and 0.37, respectively) for the occurrence of complex ventricular arrhythmias following acute myocardial infarction. Conclusion. In this study, late ventricular potentials in patients with left ventricular ejection fraction bellow 40% represented the independent predictor for the occurrence of complex ventricular arrhythmias in the first six months after the first myocardial infarction treated with accelerated tissue-type plasminogen activator, using the rapid protocol.

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