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[Ventricular tachyarrhythmia in acute and chronic myocardial ischemia: value of diagnostic procedures]
1Medizinische Klinik I, Klinikum Grosshadern.
Insights
Mortality after myocardial infarction has decreased due to improved treatments. Newer risk stratification methods, including programmed stimulation, are superior for predicting outcomes in post-myocardial infarction patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Technology
Context:
- Analysis of patient outcomes following myocardial infarction (MI).
- Evaluation of non-invasive methods for predicting outcomes in asymptomatic post-MI patients.
- Trends in ventricular fibrillation incidence and mortality post-MI since the 1970s.
Purpose:
- To differentiate key endpoints in post-MI studies, including ventricular tachycardia, ventricular fibrillation, and sudden circulatory arrest.
- To assess the prognosis of patients experiencing primary ventricular fibrillation post-MI.
- To compare the efficacy of newer risk stratification methods against conventional approaches.
Summary:
- Mortality and ventricular fibrillation incidence post-MI have declined due to multifactorial causes like improved therapies and risk factor management.
- Primary ventricular fibrillation post-MI, even without preceding symptoms, indicates a guarded prognosis, necessitating invasive evaluation.
- Advanced methods like programmed stimulation and late potential analysis show superiority over long-term ECG and exercise testing for chronic phase risk stratification.
Impact:
- Recommends differentiating specific arrhythmic events in future clinical studies.
- Highlights the need for invasive diagnostic evaluation in cases of primary ventricular fibrillation.
- Emphasizes combining arrhythmogenic substrate assessment with left ventricular ejection fraction for comprehensive risk stratification.
Abstract:
The analysis of the outcome of patients after myocardial infarction in general, as well as of studies to predict the outcome of asymptomatic post-myocardial infarction patients by non-invasive methods, leads to the following conclusions: 1) The incidence of ventricular fibrillation and mortality after acute myocardial infarction has been declining since the 1970s (2); the causes for this reduction are presumably multifactorial (thrombolysis of acute infarction, administration of ACE-inhibitors and increasing prescription of beta-blockers, improvement of intensive care medicine, rigorous correction of risk factors). 2) Development of ventricular tachycardia, electrocardiographically documented ventricular fibrillation or successful reanimation due to sudden circulatory arrest in clinical studies of post-myocardial infarction patients are endpoints which in future studies must be differentiated from each other. 3) In contrast to previous assumptions, the outcome of patients with primary ventricular fibrillation after acute myocardial infarction, that is, without preceding symptoms is guarded, so that such an event should prompt invasive diagnostic evaluation (coronary arteriography, programmed stimulation (?)). 4) Newer methods for risk stratification after myocardial infarction during the chronic phase, such as programmed stimulation, late potential analysis from the body surface as well as programmed ventricular stimulation appear to be superior to more conventional methods such as long-term ECG monitoring as well as exercise testing. It is recommended that all methods which determine the arrhythmogenic substrate are combined with a parameter of left ventricular ejection fraction because of the paramount importance of left ventricular pump function.(ABSTRACT TRUNCATED AT 250 WORDS)