Prognostic impact of early ventricular fibrillation in patients with ST-elevation myocardial infarction treated with primary PCI

Abstract

Aims: Current guidelines do not advocate implantation of cardioverter-defibrillators (ICD) for survivors of ventricular fibrillation (VF) during the first 48 hours of ST-elevation myocardial infarction (STEMI). However, contemporary studies in a real-life setting with long-term follow-up are lacking. We assessed the prognostic impact of early VF in a non-selected population of STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods and results:Consecutive STEMI patients admitted to a Swedish tertiary care hospital during 2007-2009 were identified from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (n=1718, age 66±12 years, 70% male). Patients with VF were identified from the register, and medical records were reviewed to determine the time point of VF. Patients surviving VF in the first 48 hours after symptom onset were compared with patients without VF for one-year mortality and a combined endpoint of death, resuscitated VF or appropriate ICD therapy. VF within 48 hours occurred in 7% of STEMI patients (n=121). In patients alive at 48 hours (n=1663), VF patients (n=101) had higher in-hospital mortality (12% vs. 2%, p<0.001). However, in VF patients discharged alive (n=89), mortality was low (1%) and combined endpoint rate (3%) did not differ compared with patients without VF (n=1538; 4% and 4% respectively). Conclusion:In a large non-selected population of STEMI patients treated with primary PCI, VF during the first 48 hours after STEMI is associated with increased in-hospital mortality but does not influence the long-term prognosis for those discharged alive.

Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force

“…The incidence of sustained VT and VF occurring within 48 h of the onset of an ACS seems to have decreased over the past decades. [17][18][19] This is most likely due to the widespread availability of revascularization therapy, limiting the size of infarction and to an increased use of beta-blockers. 8 However, in a recent retrospective analysis of two randomized trials sustained VA occurred in almost 6% of patients in the very early phase of acute MI indicating the significance of VT/VF in this situation.…”

Ventricular Arrhythmia after Acute Myocardial Infarction: ‘The Perfect Storm’

“…1,2 Thrombolysis primary percutaneous coronary intervention (PCI) and use of beta-blockers, while resulting in the modification of the natural history of an infarct, have also reduced the incidence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) occurring within 48 hours of the onset of an acute coronary syndrome (ACS), over the past decades. 3 The prevention and treatment of haemodynamically significant VA in the post-infarct period, and of sudden cardiac death (SCD) remote from the event, remain areas of ongoing study.…”

Predictors of Ventricular Fibrillation at Reperfusion in Patients With Acute ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

“…Because of its relatively low incidence, the predictors and prognostic value of VF at reperfusion are usually analysed together with other VF episodes at any time of acute STEMI (2)(3)(4). Some studies divided VF on early and late (2,5), some of them dealt with prereperfusion (6), periprocedural (1) or postprocedural (7) VF.…”