Factors likely to affect the long-term results of ventricular stimulation after myocardial infarction.
BACKGROUND
The results of programmed ventricular stimulation (PVS) may change after myocardial infarction (MI). The objective was to study the factors that could predict the results of a second PVS.


METHODS
Left ventricular ejection fraction (LVEF) and QRS duration were determined and PVS performed within 3 to 14 years of one another (mean 7.5+/-5) in 50 patients studied systematically between 1 and 3 months after acute MI.


RESULTS
QRS duration increased from 120+/-23 ms to 132+/-29 (p 0.04). LVEF did not decrease significantly (36+/-12 % vs 37+/-13 %). Ventricular tachycardia with cycle length (CL) > 220ms (VT) was induced in 11 patients at PVS 1, who had inducible VT with a CL > 220 ms (8) or < 220 ms (ventricular flutter, VFl) (3) at PVS 2. VFl or fibrillation (VF) was induced in 14 patients at PVS 1 and remained inducible in 5; 5 patients had inducible VT and 4 had a negative 2nd PVS. 2. 25 patients had initially negative PVS; 7 had secondarily inducible VT, 4 a VFl/VF, 14 a negative PVS. Changes of PVS were related to initially increasing QRS duration and secondarily changes in LVEF and revascularization but not to the number of extrastimuli required to induce VFl.


CONCLUSIONS
In patients without induced VT at first study, changes of PVS are possible during the life. Patients with initially long QRS duration and those who developed decreased LVEF are more at risk to have inducible monomorphic VT at 2nd study, than other patients.
Brembilla-Perrot
Beatrice
B
Department of cardiology, CHU of Brabois, Vandoeuvre, France. b.brembilla-perrot@chu-nancy.fr
Zinzius
Pierre Yves
PY
Groben
Laurent
L
Freysz
Luc
L
Muresan
Lucian
L
Schwartz
Jerome
J
Martins
Raphael P
RP
Jarmouni
Soumaya
S
Nossier
Ibrahim
I
Sadoul
Nicolas
N
Blangy
Hugues
H
De La Chaise
Arnaud Terrier
AT
Louis
Pierre
P
Selton
Olivier
O
Beurrier
Daniel
D
Sellal
Jean Marc
JM