Significance of repeat programmed ventricular stimulation at electrophysiology study for arrhythmia prediction after acute myocardial infarction.
Pacing Clin Electrophysiol
; 37(7): 795-802, 2014 Jul.
Article
em En
| MEDLINE
| ID: mdl-24666010
ABSTRACT
BACKGROUND:
The prognostic significance of a second programmed ventricular stimulation (PVS) at electrophysiology study (EPS), when the first PVS is negative for inducible ventricular tachycardia (VT), in patients following myocardial infarction (MI) is unknown.METHODS:
Consecutive ST-elevation MI patients with left ventricular ejection fraction ≤ 40% following revascularization underwent early EPS. An implantable cardioverter defibrillator (ICD) was implanted for a positive (inducible monomorphic VT) but not a negative (no arrhythmia or inducible ventricular fibrillation [VF]/flutter) EPS. The combined primary end point of death or arrhythmia (sudden death, resuscitated cardiac arrest, and spontaneous VT/VF) was assessed in EPS-positive patients grouped according to if VT was induced on the first PVS application, or the second PVS application, when the first was negative.RESULTS:
EPS performed a median 8 days post-MI in 290 patients was negative in 70% (n = 203) and positive in 30% (n = 87). In patients with a positive EPS, VT was induced on the first PVS in 67% (n = 58) and the second PVS, after the first was negative, in 33% (n = 29). Predischarge ICD was implanted in 79 of 87 patients with a positive EPS. Three-year primary end point occurred in 20.9 ± 5.6% and 38.3 ± 9.7% of patients with VT induced by the first and second PVS, respectively (P = 0.042) and in 6.3 ± 1.9% of electrophysiology-negative patients (P < 0.001).CONCLUSIONS:
In patients with post-MI left ventricular dysfunction, VT can be induced in a significant proportion with a second PVS when negative on the first. These patients have a similar higher risk of death or arrhythmia compared to patients with VT induced on the first PVS.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Função Ventricular Esquerda
/
Morte Súbita Cardíaca
/
Taquicardia Ventricular
/
Desfibriladores Implantáveis
/
Técnicas Eletrofisiológicas Cardíacas
/
Estimulação Elétrica
/
Infarto do Miocárdio
Tipo de estudo:
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Pacing Clin Electrophysiol
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Austrália