title: Ventricular arrhythmia burst is an independent indicator of larger infarct size even in optimal reperfusion in STEMI.
abstract: We hypothesized that ventricular arrhythmia (VA) bursts during reperfusion phase are a marker of larger infarct size despite optimal epicardial and microvascular perfusion.
  
  
  
  126 STEMI patients were studied with 24h continuous, 12-lead Holter monitoring. Myocardial blush grade (MBG) was determined and VA bursts were identified against subject-specific background VA rates in core laboratories. Delayed-enhancement cardiovascular magnetic resonance imaging was used to determine infarct size.
  
  
  
  In the group with MBG 3 no significant differences were found for baseline characteristics between burst versus no burst (102 vs. 24). In those with optimal epicardial and microvascular reperfusion (TIMI 3, stable ST-recovery, and MBG 3), VA burst was associated with larger infarct size (N=102/126; median 11.0 vs. 5.1%; p=0.004).
  
  
  
  In the event of MBG 3, VA bursts were associated with significantly larger infarct size even if optimal epicardial and microvascular reperfusion was present.
authors.affiliation: Maastricht University Medical Center, Maastricht, The Netherlands; Duke University Medical center and Duke Clinical Research Institute, Durham, USA. Electronic address: kirianvanderweg@gmail.com.
authors.forename: Kirian
authors.initials: K
authors.lastname: van der Weg
authors.affiliation: Maastricht University Medical Center, Maastricht, The Netherlands; Duke University Medical center and Duke Clinical Research Institute, Durham, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Majidi
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Joost D E
authors.initials: JD
authors.lastname: Haeck
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Duke University Medical center and Duke Clinical Research Institute, Durham, USA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Green
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Wichert J
authors.initials: WJ
authors.lastname: Kuijt
authors.affiliation: Duke University Medical center and Duke Clinical Research Institute, Durham, USA.
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
authors.affiliation: Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Anton P M
authors.initials: AP
authors.lastname: Gorgels
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D000465:Algorithms; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D011379:Prognosis; D020127:Recovery of Function; D015203:Reproducibility of Results; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control
keywords: Magnetic resonance imaging; Microvascular obstruction; Myocardial infarction; Ventricular arrhythmias