Coronary artery reperfusion for ST elevation myocardial infarction is associated with shorter cycle length ventricular tachycardia and fewer spontaneous arrhythmias

Nalliah, C.; Zaman, Sarah; Narayan, Arun; Sullivan, Janice; Kovoor, Pramesh

doi:10.1093/europace/eut307

Cited by 17 publications

(5 citation statements)

References 32 publications

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“…438,439 Early reperfusion therapy reduces the risk of ventricular arrhythmias and cardiovascular death. 440,441 The presence of life-threatening arrhythmias requires an urgent need for a fast and complete revascularization in STEMI. 438,442 The evidence for benefits of antiarrhythmic drugs in STEMI patients is limited and negative effects of antiarrhythmic drugs on early mortality have been demonstrated.…”

Section: Management Of Arrhythmias and Conduction Disturbances In Thementioning

confidence: 99%

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

Ibáñez¹,

James²,

Antunes³

et al. 2017

European Heart Journal

7,334

1,945

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The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC (journals.permissions@oxfordjournals.org). Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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Section: Management Of Arrhythmias and Conduction Disturbances In Thementioning

confidence: 99%

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

Ibáñez¹,

James²,

Antunes³

et al. 2017

European Heart Journal

7,334

1,945

View full text Add to dashboard Cite

show abstract

“…However, our findings contradicted the hypothesis that STEMI patients without SMuRFs may be more sensitive to inducible VT, clearly demonstrating lower rates than those observed in patients with at least one standard risk factor. The rigorous approach we have validated over the last decade strengthened our study ( 6 , 8 , 15 – 17 ).…”

Section: Discussionmentioning

confidence: 86%

Influence of standard modifiable risk factors on ventricular tachycardia after myocardial infarction

Deshmukh,

Kovoor,

Byth

et al. 2023

Front. Cardiovasc. Med.

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BackgroundInducible ventricular tachycardia (VT) at electrophysiology study (EPS) predicts sudden cardiac death because of ventricular tachyarrhythmia, the single greatest cause of death within 2 years after myocardial infarction (MI).ObjectivesWe aimed to assess the association between standard modifiable risk factors (SMuRFs) and inducible VT at EPS early after MI.MethodsConsecutive patients with left ventricle ejection fraction ≤40% on days 3–5 after ST elevation MI (STEMI) who underwent EPS were prospectively recruited. Positive EPS was defined as induced sustained monomorphic VT cycle length ≥200 ms for ≥10 s or shorter if hemodynamically compromised. The primary outcome was inducibility of VT at EPS, and the secondary outcome was all-cause mortality on follow-up.ResultsIn 410 eligible patients undergoing EPS soon (median of 9 days) after STEMI, 126 had inducible VT. Ex-smokers experienced an increased risk of inducible VT [multivariable logistic regression adjusted odds ratio (OR) 2.0, p = 0.033] compared with current or never-smokers, with comparable risk. The presence of any SMuRFs apart from being a current smoker conferred an increased risk of inducible VT (adjusted OR 1.9, p = 0.043). Neither the number of SMuRFs nor the presence of any SMuRFs was associated with mortality at a median follow-up of 5.4 years.ConclusionsIn patients with recent STEMI and impaired left ventricular function, the presence of any SMuRFs, apart from being a current smoker, conferred an increased risk of inducible VT at EPS. These results highlight the need to modify SMuRFs in this high-risk subset of patients.

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“…Our group previously demonstrated that delays in reperfusion led to a six-fold increase in VT inducibility following AMI and a threefold increase in spontaneous VT at 2 years. 27 Similarly, we have also shown that shorter door-to-balloon times and early reperfusion result in shorter cycle lengths of induced VT. 28 We also appreciate that our retrospective study excluded patients with VT of shorter durations (less than 10 s), which has since been recognised as having a similar predictive value to VT persisting for 10 s or more. 29 Interestingly, our results also found that patients with inducible VT post-STEMI deemed remote from scar had no events of death or clinically significant VA at median follow-up period of 57 months.…”

Section: Discussionmentioning

confidence: 93%

Correlation of exit sites of inducible ventricular tachycardia post‐ST elevation myocardial infarction on electrophysiology study, with region of infarct

Rao

Danaila

Bennett

et al. 2022

Internal Medicine Journal

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BackgroundVentricular arrhythmia (VA) is the most common cause of sudden cardiac death post‐ST elevation myocardial infarction (STEMI). Ventricular tachycardia (VT) may be inducible in electrophysiology studies (EPS) early (<40 days) post‐STEMI. Whether it originates from the infarct site remains unknown. We examined the correlation between inducible VT and infarct location post‐STEMI.AimsTo investigate the correlation between inducible VT and infarct location post‐STEMI.MethodsWe retrospectively analysed 46 patients from 2005 to 2017 with STEMI who underwent early programmed ventricular stimulation through EPS (>48 h post‐STEMI and <40 days from admission). Gated heart pool scans were used to visualise infarct scar regions, and VT exit sites were derived from induction 12‐lead electrocardiography. Patients were followed up for primary outcomes of recurrent VA and all‐cause mortality.ResultsForty‐six patients were included for analysis, with 50 uniquely induced VT exit sites. Mean left ventricular ejection fraction was 30 ± 8.7% and 22% had impaired right ventricular ejection fraction. Mean time from presentation to EPS was 16 ± 31.3 days. Of the induced VT, 44 (88%) were from within scar and scar‐border regions, whereas 6 (12%) of the induced VT were found to be remote to imaging‐derived scar. Over a median follow‐up period of 75 months, 6 (13%) patients died, and 7 (15%) patients had recurrent VA. No deaths occurred in patients with remote VT.ConclusionThe majority of early inducible post‐infarct VT arises from acute myocardial scar; however, a small portion arises from sites remote from scars with a possible focal aetiology.

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Coronary artery reperfusion for ST elevation myocardial infarction is associated with shorter cycle length ventricular tachycardia and fewer spontaneous arrhythmias

Abstract: Patients receiving early reperfusion for STEMI had faster inducible and spontaneous VT and fewer spontaneous recurrences. This may be due to changes in the myocardial substrate as a result of early coronary artery reperfusion.

Cited by 17 publications

References 32 publications

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

Influence of standard modifiable risk factors on ventricular tachycardia after myocardial infarction

Correlation of exit sites of inducible ventricular tachycardia post‐ST elevation myocardial infarction on electrophysiology study, with region of infarct

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