[Value of searching ventricular late potentials in patients recovering from ventricular fibrillation].
The prognostic value of ventricular late potentials (VLP) was studied in 38 survivors of ventricular fibrillation (VF) resuscitated after cardiac arrest. Thirty-seven patients had coronary artery disease, 24 within one month of myocardial infarction, and one patient had valvular heart disease. There were 7 deaths within 2 years, including 5 sudden deaths, the average follow-up in the remaining patients being 46 +/- 30 months. Bad prognostic factors included low left ventricular ejection fraction, anterior myocardial infarction, VF occurring after the first 24 hours of myocardial infarction and the presence of VLP. The 2 year mortality rate was 35% in patients with VLP compared with only 5% when they were absent (p < 0.05). The subgroup with the highest risk of death was that of anterior myocardial infarcts with VLP (45% 2 year mortality). The clinical circumstances surrounding VF were important; patients with clinical and electrical signs of ischaemia at the time of VF tended to have a better prognosis than the others, especially in the absence of VLP: in this subgroup of 12 "ischaemic" VFs without VLP the mortality at 2 years was nil, whereas the other 26 patients had a 27% death rate (0.05 < p < 0.10). Programmed ventricular stimulation was only carried out in 14 cases: it showed that the long-term mortality was very high (60%) in patients with VLP and inducible ventricular tachycardia (VT). Therefore, the implantation of an automatic defibrillator device would seem to be justified in patients resuscitated from VF who have both VLP and inducible VT, but of no value in cases of "ischaemic" VF without VLP.
Leclercq
J F
JF
Service de cardiologie, hôpital Lariboisière, Paris.
Gounaropoulou
N
N
Cauchemez
B
B
Chouty
F
F
Leenhardt
A
A
Beaufils
P
P
Coumel
P
P
Slama
R
R
D000200:Action Potentials; D000206:Actuarial Analysis; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012151:Resuscitation; D012306:Risk; D013318:Stroke Volume; D014693:Ventricular Fibrillation / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy
Intérêt de la recherche des potentiels tardifs ventriculaires chez les patients réanimés de fibrillation ventriculaire.