Arrhythmias in the post CCU phase of myocardial infarction: their correlation with the acute illness
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Premature ventricular contractions (PVCs) are very common after myocardial infarction hospitalization. Frequent and complex PVCs often persist from the coronary care unit (CCU).
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Critical Care Medicine
Background:
- Myocardial infarction (MI) patients are at risk for cardiac arrhythmias.
- Continuous monitoring in the coronary care unit (CCU) identifies some arrhythmias.
- The frequency and predictors of arrhythmias after CCU transfer remain unclear.
Purpose of the Study:
- To determine the incidence of potentially life-threatening arrhythmias in myocardial infarction patients post-CCU transfer.
- To identify acute illness features that predict these late-phase arrhythmias.
Main Methods:
- Sixty-six myocardial infarction patients were continuously monitored using a computer-assisted system.
- Arrhythmias were assessed following transfer from the coronary care unit (CCU).
- Premature ventricular contractions (PVCs) were classified using the Lown grading system.
Main Results:
- Premature ventricular contractions (PVCs) were detected in 97% of patients after CCU transfer.
- 44% of patients exhibited Lown grades 2-4 PVCs; 3.0% had ventricular tachycardia.
- No correlation found between arrhythmias and patient demographics, infarct characteristics, or heart failure.
Conclusions:
- Potentially life-threatening arrhythmias, particularly PVCs, are nearly universal in the late hospitalization phase of myocardial infarction.
- Frequent and complex PVCs are common and often indicate persistent arrhythmia issues from the CCU.
- Antiarrhythmic drug use (procainamide, quinidine) correlated with more severe PVCs.
Abstract:
To estimate the frequency of potentially life-threatening arrhythmias in myocardial infarction following transfer from the coronary care unit (CCU) and to identify features of the acute illness which predict such events, 66 patients were monitored on-line by means of a computer assisted system. Premature ventricular contractions (PVCs) were detected following transfer from the CCU in 64 patients (97%). In 29 (44%) they fell in classes 2 to 4 of Lown. Accelerated ventricular rhythm was detected in five and ventricular tachycardia in three. The presence of these rhythm disturbances did not correlate with age, sex, infarct location, the occurrence of previous infarction, the level of serum cardiac enzymes, the presence of heart failure, atrial arrhythmias, heart block, or serious ventricular arrhythmia in the CCU. Use of procaine amide or quinidine for persistent ventricular arrhythmia in the CCU was correlated with detection of class 2, 3 or 4 PVCs. Thus, PVCs are nearly universal in the late phase of hospitalization for myocardial infarction. Frequent and complicated PVCs are common and occur most frequently in individuals in whom such events have been persistent in the CCU.