Incidence of Ventricular Fibrillation and Sustained Ventricular Tachycardia Complicating Non-ST Segment Elevation
Asher Schnur1, Moshe Rav Acha1, Ranel Loutati1
1Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel.
Insights
Ventricular fibrillation (VF) and ventricular tachycardia (VT) are rare in non-ST elevation myocardial infarction (NSTEMI) patients. These findings suggest NSTEMI patients may not require routine intensive coronary care unit monitoring.
Area of Science:
- Cardiology
- Clinical Medicine
- Critical Care
Background:
- Ventricular arrhythmias like VF/VT are life-threatening in acute myocardial infarction (MI).
- Data on VF/VT in non-ST elevation myocardial infarction (NSTEMI) is limited compared to STEMI.
- Understanding VF/VT incidence in NSTEMI is crucial for patient management.
Purpose of the Study:
- To determine the incidence of VF/VT in NSTEMI patients admitted to an intensive coronary care unit (ICCU).
- To evaluate the need for routine monitoring in NSTEMI patients.
Main Methods:
- Prospective, single-center study.
- Monitored 732 NSTEMI patients admitted to ICCU from June 2019 to December 2022.
- Analyzed demographics, symptoms, comorbidities, and laboratory/imaging data.
Main Results:
- Only 3 (0.4%) confirmed NSTEMI patients developed VF/VT during admission.
- Three additional cases initially diagnosed as NSTEMI were reclassified as STEMI.
- No deaths occurred within the 1-year follow-up period.
Conclusions:
- VF/VT is a rare complication in NSTEMI patients managed with contemporary guidelines and early invasive strategies.
- Routine monitoring and ICCU admission may not be necessary for all NSTEMI patients.
Abstract:
Background: Primary ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) are potentially lethal complications in patients suffering from acute myocardial infarction (MI). In contrast with the profound data regarding the incidence and prognostic value of ventricular arrhythmias in ST elevation myocardial infarction (STEMI) patients, data regarding contemporary non-ST elevation myocardial infarction (NSTEMI) patients with ventricular arrhythmias is scarce. The aim of the current study was to investigate the incidence of VF/VT complicating NSTEMI among patients admitted to an intensive coronary care unit (ICCU). Methods: Prospective, single-center study of patients diagnosed with NSTEMI admitted to ICCU between June 2019 and December 2022. Data including demographics, presenting symptoms, comorbid conditions, and physical examination, as well as laboratory and imaging data, were analyzed. Patients were continuously monitored for arrhythmias during their admission. The study endpoint was the development of VF/sustained VT during admission. Results: A total of 732 patients were admitted to ICCU with a diagnosis of NSTEMI. Of them, six (0.8%) patients developed VF/VT during their admission. Nevertheless, three were excluded after they were misdiagnosed with NSTEMI instead of posterior ST elevation myocardial infarction (STEMI). Hence, only three (0.4%) NSTEMI patients had VF/VT during admission. None of the patients died during 1-year follow-up. Conclusions: VF/VT in NSTEMI patients treated according to contemporary guidelines including early invasive strategy is rare, suggesting these patients may not need routine monitoring and ICCU setup.
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