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[Relation between spontaneous and electrically inducible ventricular arrhythmias in patients with coronary heart
Insights
Programmed electrical stimulation (PES) can induce ventricular arrhythmias in coronary artery disease patients, with higher incidence in those with myocardial infarction history. Arrhythmia induction via PES correlates with spontaneous arrhythmias detected on Holter monitoring.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Context:
- Coronary artery disease (CAD) patients often experience ventricular arrhythmias.
- Programmed electrical stimulation (PES) is a diagnostic tool for assessing arrhythmia inducibility.
- Comparing induced arrhythmias with spontaneous arrhythmias provides insights into cardiac electrical stability.
Purpose:
- To compare induced ventricular arrhythmias during PES with spontaneous arrhythmias recorded via 24-hour Holter monitoring in CAD patients.
- To investigate the relationship between myocardial infarction history and the inducibility of ventricular arrhythmias.
- To analyze the impact of time elapsed since myocardial infarction on arrhythmia induction.
Summary:
- A prospective study of 267 CAD patients showed that PES induced ventricular arrhythmias in a significant portion, with higher rates in those with a history of myocardial infarction.
- Induced arrhythmias during PES correlated with spontaneous arrhythmias observed during Holter monitoring, particularly complex arrhythmias (Lown-class III-IV).
- While the incidence of inducible 3-5 repetitive ventricular responses (RVR) remained stable over time post-infarction, the frequency of >6 RVR decreased.
Impact:
- This study highlights the utility of PES in identifying patients at risk for ventricular arrhythmias in the context of coronary artery disease.
- Findings suggest that PES-induced arrhythmias can serve as a surrogate marker for spontaneous arrhythmias, aiding in risk stratification.
- Understanding the temporal relationship between myocardial infarction and arrhythmia inducibility can inform clinical management strategies.
Abstract:
In a prospective study, 267 patients with invasively diagnosed coronary artery disease were studied by programmed electrical stimulation (PES) and induced ventricular arrhythmias were compared to spontaneous arrhythmias occurring during 24 h Holter registration. In 89 patients (33%) no evidence of myocardial infarction was present, 61 patients (23%) were studied for 6 weeks to 3 months, 36 patients (13%) for 3-6 months and 81 patients (31%) for more than 6 months after myocardial infarction. PES was performed in the right ventricular apex with 1 and 2 extrastimuli during pacing with 100, 120 and 140 beats/min. Endpoint of the study was defined by the induction of 4 repetitive ventricular responses (RVR). Within 72 hours after PES a 24 h Holter registration was performed in all patients. During PES, 15 patients (6%) were not inducible for any RVR. Single RVR (1-2) were induced in 146 patients (55%) and 3-5 RVR in 68 patients (25%). Ventricular tachycardia and ventricular fibrillation were induced in 38 patients (14%); 6 patients showed a sustained, monomorphic tachycardia. Altogether, the incidence of RVR was higher when a history of myocardial infarction was present. With increasing time after infarction the incidence of inducible 3-5 RVR remained stable; however, the number of greater than 6 RVR decreased. During Holter registration, 54/255 patients (21%) showed no spontaneous ventricular arrhythmias, 70 patients (28%) had arrhythmias of Lown-class I/II, 84 patients (33%) of Lown-class III. Complex arrhythmias were observed in 47 patients (18%) (Lown-class IVA: 33 patients, IVB: 14 patients).(ABSTRACT TRUNCATED AT 400 WORDS)