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Ventricular tachycardia associated with acute myocardial infarction--features, therapeutic effect and prognosis
Insights
Ventricular tachycardia (VT) occurs in 16.1% of acute myocardial infarction (AMI) patients, increasing mortality. Early and frequent VT, especially with severe heart failure, indicates a poor prognosis.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Acute myocardial infarction (AMI) is a leading cause of cardiac morbidity and mortality.
- Ventricular tachycardia (VT) is a serious complication of AMI, associated with increased risk of sudden cardiac death and heart failure.
Purpose of the Study:
- To investigate the incidence, clinical features, and treatment outcomes of VT in patients with AMI.
- To identify predictors of VT occurrence and prognosis in the context of AMI.
Main Methods:
- Retrospective analysis of 310 patients with AMI.
- Data collection on VT incidence, patient demographics, clinical characteristics, arrhythmias, and treatment modalities.
- Statistical analysis to compare outcomes between VT and non-VT groups and to identify prognostic factors.
Main Results:
- VT occurred in 16.1% of AMI patients, with higher incidence in inferior infarction and those with severe heart failure.
- VT was associated with increased ventricular fibrillation and mortality.
- Two peaks of VT occurrence were observed: early (day 1) and late (4th week), particularly in anterior infarction.
- Supraventricular arrhythmias preceded VT more often than ventricular premature beats.
- Successful VT termination rates varied by treatment: thump-version (63.9%), lidocaine (61.5%), disopyramide (66.7%), and mexiletine (100%).
- Class Ia antiarrhythmics showed a stronger prophylactic effect, and IABP was effective in some cases.
- Frequent and late-onset VT, combined with severe heart failure, predicted a poor prognosis.
Conclusions:
- VT is a significant complication of AMI with distinct epidemiological and clinical features.
- Early recognition and appropriate management of VT are crucial for improving outcomes in AMI patients.
- Prognosis is influenced by VT timing, frequency, and the presence of severe heart failure.
Abstract:
This study was performed to delineate the precise features and the treatment of ventricular tachycardia (VT) with acute myocardial infarction (AMI). Results indicate: 1) the incidence of VT in 310 AMI patients was 16.1% (50 patients); 2) the higher incidence of ventricular fibrillation and mortalities were observed in VT group compared with non-VT group; 3) the incidence of VT was higher in inferior infarction group (21.0%) than anterior group (13.1%); 4) more frequent VT were seen in patients with more severe heart failure; 5) two peaks of VT occurrence, on the first day and in the 4th week after the onset of AMI, were recognized especially in anterior infarction group; 6) supraventricular arrhythmias were more frequent than ventricular premature beats during one minute preceding VT; 7) the successful termination of VT was achieved in 63.9% of episodes by thump-version, 61.5% by lidocaine, 66.7% by disopyramide and 100% by mexiletine; 8) prophylactic effect on VT by class Ia antiarrhythmic agents seemed stronger than others; 9) IABP was effective to prevent VT in some cases; 10) poor prognosis was determined by frequent and later onset of VT, and combination of severe heart failure.