Prognostic significance of ventricular arrhythmias post-myocardial infarction.
Despite improvements in management strategies, ventricular arrhythmias remain important markers of electrical instability and contribute to the identification of patients at increased risk of sudden cardiac death post-myocardial infarction (MI). Over the past 20 years, understanding of pathophysiological mechanisms and implications of various types of ventricular arrhythmias has evolved remarkably. This systematic review details the prognostic significance of ventricular arrhythmias classified by type and time of onset post-MI. Subacute and late premature ventricular complexes are associated with increased mortality independent of left ventricular function. Although nonsustained ventricular tachycardia (VT) in the acute phase post-MI is of questionable significance, later onset heralds poorer prognosis. Sustained monomorphic VT in the acute post-MI phase is associated with infarct extension, heart failure and increased mortality. Extensive wall motion abnormalities, left ventricular dysfunction and aneurysm formation correlate with later postinfarct sustained VT. Inhospital mortality is higher when ventricular fibrillation presents in the acute phase but long term prognosis is not adversely affected.
Khairy
Paul
P
Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada. pkhairy@cardio.tch.harvard.edu
Thibault
Bernard
B
Talajic
Mario
M
Dubuc
Marc
M
Roy
Denis
D
Guerra
Peter G
PG
Nattel
Stanley
S
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000145:classification* / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
D000889:Anti-Arrhythmia Agents