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Usefulness of early versus late programmed ventricular stimulation in acute myocardial infarction
A Nogami1, K Aonuma, A Takahashi
1Second Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
Insights
Programmed ventricular stimulation after acute myocardial infarction (AMI) is prognostic. Late testing (day 36) for inducible sustained monomorphic ventricular tachycardia (VT) is more accurate than early testing (day 19) for predicting cardiac events.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Assessing risk after acute myocardial infarction (AMI) is crucial.
- Programmed ventricular stimulation (PVS) is used to evaluate arrhythmia risk.
- The optimal timing for PVS after AMI is not well-defined.
Purpose of the Study:
- To investigate the influence of timing on the prognostic value of PVS after AMI.
- To compare the predictive accuracy of early versus late PVS for adverse cardiac events.
Main Methods:
- 32 patients underwent PVS on day 19 (early) and day 36 (late) after AMI.
- Stimulation used up to 3 extrastimuli to induce ventricular arrhythmias.
- Outcomes included inducible sustained monomorphic ventricular tachycardia (VT) and clinical events during follow-up.
Main Results:
- Inducible sustained monomorphic VT was observed in 38% (early) and 25% (late) of patients.
- Inducibility of sustained monomorphic VT at both early and late testing predicted cardiac events.
- Late PVS demonstrated higher sensitivity (100%) and specificity (89%) compared to early PVS (80%, 70%).
Conclusions:
- PVS is a valuable tool for risk stratification after AMI.
- Late PVS (day 36) offers superior prognostic accuracy for identifying patients at risk of sudden cardiac death or sustained VT.
- Timing of PVS influences its predictive value, with later testing being more reliable.
Abstract:
To determine the influence of timing on the prognostic value of programmed ventricular stimulation after acute myocardial infarction (AMI), 32 patients were studied on day 19 (early study) and again on day 36 (late study) after AMI using up to 3 extrastimuli. At the early study, sustained monomorphic ventricular tachycardia (VT) was induced in 12 patients (38%), sustained polymorphic VT in 8 (25%), nonsustained monomorphic VT in 1 (3%), nonsustained polymorphic VT in 1 (3%) and no inducible arrhythmia in 10 (31%). At the late study, sustained monomorphic VT, nonsustained monomorphic VT and nonsustained polymorphic VT were induced in 8 patients (25%) each, and no inducible arrhythmia in 8 (25%). Of the 12 patients who had inducible sustained monomorphic VT at the early study, 7 had noninducibility of sustained monomorphic VT at the late study. Of the 20 patients who had noninducibility of sustained monomorphic VT at the early study, 3 had inducible sustained monomorphic VT at the late study. During the follow-up period (mean +/- standard deviation 21 +/- 8 months), there were 2 sudden cardiac deaths and 3 occurrences of sustained VT. Univariate analysis revealed both inducibilities of sustained monomorphic VT at the early study (p = 0.045) and at the late study (p less than 0.001) to be predictive of sudden cardiac death or clinical occurrence of sustained VT. However, inducibility of sustained monomorphic VT at the late study had a higher sensitivity (100%), specificity (89%), positive predictive value (63%) and negative predictive value (100%) than at the early study (80, 70, 33 and 95%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)