Heart rate and ectopic prematurity in relation to sustained ventricular arrhythmias

Forty-four patients with acute myocardial infarction were studied using 24-hour electrocardiographic monitoring. A linear correlation has been shown to exist between heart rate preceding accelerated idioventricular rhythm and ventricular tachycardia and the rates of these. The prematurity index was found to be inversely related to the preceding heart rate and also to the rate of accelerated idioventricular rhythm or ventricular tachycardia. Faster heart rates preceded extrasystoles with shorter prematurity indices and a significant inverse correlation was observed between preceding heart rate and prematurity index. Patients developing ventricular tachycardia had more frequent isolated ventricular extrasystoles and faster heart rates preceding the episode as compared with patients not showing ventricular tachycardia. No association was observed between ventricular tachycardia and accelerated idioventricular rhythm. All four patients developing ventricular fibrillation showed preceding ventricular tachycardia, with three of these patients demonstrating faster rates of ventricular tachycardia (greater than 170/min) and shorter prematurity indices (less than 0.80) than patients without ventricular fibrillation. Heart rate may influence the severity of ventricular arrbythmia; the prematurity of an extrasystole is of importance in patients developing accelered idioventricular rhythm or ventricular tachycardia.