[The differential characteristics of early ventricular arrhythmias following a myocardial infarct in patients with and without ventricular fibrillation].
OBJECTIVE
To evaluate the characteristics of early ventricular arrhythmias in acute myocardial infarction and their predictive value of ventricular fibrillation.


METHODS
We retrospectively compared 85 patients who presented ventricular fibrillation with a control group of 187 consecutively acute myocardial infarction patients recorded within the first 12 hours after onset of acute myocardial infarction symptoms. Patients in Killip class III-IV were excluded.


RESULTS
In the ventricular fibrillation group we observed a high prevalence of inferior site of infarction (69 vs 56%; p < 0.05), sum of ST in 3 leads (ST-3 leads) with maximal elevation (13 +/- 17 vs 8 +/- 7 mm; p < 0.005), basic heart rate (97 +/- 23 vs 88 +/- 18 bpm; p < 0.01), R-on-T phenomenon (16 vs 2%; p < 0.001). In 22 patients in whom the ventricular fibrillation episode was registered, the basic heart rate preceding the ventricular fibrillation was fast (113 +/- 54 bpm), and the prematurity index (coupling interval/QT) shorter than in the other ventricular arrhythmias (0.9 +/- 0.2 vs 1.2 +/- 0.3 s respectively; p < 0.005). The prematurity index of ventricular arrhythmias in the ventricular fibrillation group was shorter than in the control group (1.2 +/- 0.3 vs 1.5 +/- 0.3 s respectively; p < 0.0001) and the heart rate during runs was faster (172 +/- 54 vs 126 +/- 40 bpm; p < 0.01). The logistic regression analysis showed that R-on-T phenomenon (odds ratio [OR] = 2.8), inferior site of infarct (OR = 3.65), sum of ST-3 leads > 10 mm (OR = 5.82), and basic heart rate > 100 bpm (OR = 2.33) were independent risk factors for ventricular fibrillation.


CONCLUSIONS
Characteristic ventricular arrhythmias were found to precede ventricular fibrillation episodes: R-on-T phenomenon or short prematurity index and fast runs of ventricular tachycardia, with other parameters such a inferior site of infarct, sum of ST-3 leads > 10 mm and basic heart rate > 100 bpm.
Fiol Sala
M
M
Unidad Coronaria-UCI, Hospital Son Dureta, Palma de Mallorca.
Marrugat
J
J
Bergadá García
J
J
Guindo Soldevila
J
J
Bayés de Luna
A
A
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology
Características diferenciales de las arritmias ventriculares precoces tras un infarto de miocardio en pacientes con y sin fibrilación ventricular.