[Revascularization of the myocardium and electrical instability of the ventricles].
The objective of the investigation was to evaluate in patients with chronic ischaemic heart disease (IHD) and malignant ventricular tachyarrhythmia the asset of myocardial revascularization for improvemet of the electric instability of the ventricular myocardium and a subsequent outline of the tactics of antiarrhythmic treatment. The authors included in the group a total of 35 patients (30 men and 5 women), age 34-78 years (mean 61 +/- 11) with IHD (according to selective coronarography) with spontaneous ventricular fibrillation (18 sebjects) or persistent (above 30s) marked symptomatic ventricular tachycardia (17 subjects), after ruling out acute cardiac infarction. The group was divided into a subgroups of 16 subjects with revascularization of the heart muscle (coronary angioplasty, coronary bypass) and a subgroup (19 subjects) without revascularization of the hearth muscle. In both groups programmed stimulation of the cardiac chambers was implemented (PSSK) (apparatuses of Qinton Co. USA, Biotronik, GFR), in the subgroup after revascularization within three months. In case of a PSSK finding the authors tested antiarrhythmic drugs, most frequently amiodarone by the oral route (within one month). Treatment not causing permanent ventricular arrhythmia was considered effective. In the subgroup with revascularization the authors described diagnostic PSSK in 8 subject where testing of antiarrhythmics was made in 6 patients (an effective antiarrhythymic agent was found in one instance, i.e. in 16.7%). In the subgroup without revascularization diagnostic PSSK was implemented in 17 subject. Antiarrythmic drugs were tested in 16 patients (effective treatment in 12.5%--always amiodaroe by the oral route). Diagnostic ventricular tachyarrhythmia was found in patients with spontaneous ventricular tachycardia in all instances with revascularization and in 92.3% without revascularization. In patients with spontaneous ventricular fibrillation they proved diagnostic PSSK in 33.3% of the patients with revascularization and in 66.7% without revascularization. The relative number of implantation of cardioverter-defibrillators in group with and without revascularization was similar (25%, 26.3%). Revascularization of the heart muscle in patients with chronic IHD reduces markedly the electric instability of the ventricular heart muscle, in particular in case of spontaneou ventricular fibrillation. Selective coronarography and possibly revascularization of the heart muscle is esential in those patients. The tactics of antiarrhythymic treatment of revascularization of the heart muscle were not affected.
Pleskot
M
M
II. interní klinika FN, Hradec Králové.
Parízek
P
P
Hodac
M
M
Haman
L
L
St'ásek
J
J
Cervinka
P
P
Tauchman
M
M
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D017180:Tachycardia, Ventricular / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D016277:Ventricular Function, Left