Significance of inducible ventricular flutter-fibrillation after myocardial infarction.
OBJECTIVE
The purpose of this study was to determine the factors associated with the induction of ventricular flutter/fibrillation (VFl/VF)and its prognostic significance in post-myocardial infarction.


METHODS
Programmed ventricular stimulation was performed after myocardial infarction (MI) for syncope (n = 232) or systematically (n = 755); 230 patients had an induced VFl/VF and were followed during 4 +/- 2 years.


RESULTS
VFl/VF was induced in 49/232 patients (21%) with syncope versus 181/755 asymptomatic patients (24%) (NS) and 94/410 patients (23%) with left ventricular ejection fraction (LVEF) <40% versus 136/577 patients (22.5%) with LVEF >40% (NS). Cardiac mortality was 9%; LVEF was 33 +/- 15% in patients who died, 43 +/- 13% in alive patients (P < 0.004). In patients with LVEF <40%, induced VFl/VF, mortality rate was 31% in those with syncope, 10% in asymptomatic patients (P < 0.001), because of an increase of deaths by heart failure; patients with LVEF >40% with or without syncope had a low mortality (5% and 3%). After linear logistic regression, VFl/VF and LVEF were predictors of total cardiac mortality, but only LVEF <40% predicted sudden death.


CONCLUSIONS
Syncope and the level of LVEF did not increase the incidence of VFl/VF induction after MI, but modified the cardiac mortality: induced VF increased total cardiac mortality in patients with syncope and LVEF <40%, but did not increase sudden death. In patients with LVEF >40%, induced VFl/VF has no significance neither in asymptomatic patients nor in those with syncope.
Brembilla-Perrot
Béatrice
B
Cardiology, CHU of Brabois, 54500 Vandoeuvre, France. b.brembilla-perrot@chu-nancy.fr
Suty-Selton
Christine
C
Claudon
Olivier
O
Terrier de la Chaise
Arnaud
A
Louis
Pierre
P
Nippert
Marc
M
Popovic
Batric
B
Blangy
Hugues
H
Khaldi
Emad
E
Belhakem
Hadj
H
Beurrier
Daniel
D
Houriez
Pierre
P
D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012044:Regression Analysis; D013575:Syncope / Q000401:mortality / Q000628:therapy*; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000209:etiology / Q000401:mortality / Q000628:therapy*