Determinants of the hemodynamic consequence to sustained ventricular arrhythmias after a single myocardial infarction.
Patients who have sustained ventricular arrhythmias after myocardial infarction present with either a cardiac arrest or with hemodynamically stable sustained ventricular tachycardia. Recent reports have suggested a different electrophysiologic milieu in these two patient groups and a higher incidence of cardiac arrest in patients with a history of more than one myocardial infarction. No studies have examined patients with only a single previous myocardial infarction. To assess the determinants of the hemodynamic consequence of sustained ventricular arrhythmias more than 3 days after a single myocardial infarction, 82 patients who were resuscitated from arrhythmic cardiac arrest (CA group, 40 patients) or who had hemodynamically stable sustained ventricular tachycardia (No CA group, 42 patients) were examined. Patients in both groups had similar global left ventricular ejection fractions (mean +/- SD; 30% +/- 12% vs 27% +/- 12%; p = NS), proportion of patients with anterior wall infarctions as compared with the proportion of patients with inferior wall infarctions (55% vs 50%; p = NS), time from infarction to arrhythmia development, severity of coronary artery disease, and the proportion of patients with congestive heart failure or bundle branch block. Patients who presented without cardiac arrest, however, more frequently had left ventricular aneurysms (58% vs 28%; p = 0.005). Sixty-seven patients underwent baseline drug-free electrophysiologic studies. Sustained ventricular tachycardia was induced in 79% of patients in the CA group and 85% of patients in the No CA group (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
Sager
P T
PT
Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
Perlmutter
R A
RA
Rosenfeld
L E
LE
Batsford
W P
WP
D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D004562:Electrocardiography; D005260:Female; D015637:Gated Blood-Pool Imaging; D006322:Heart Aneurysm / Q000209:etiology / Q000503:physiopathology; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006327:Heart Block / Q000209:etiology; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left