Prognostic importance of ventricular extrasystoles in acute myocardial infarction

Abstract

SummaryVentricular arrhythmias were recorded in 233 patients in a prospective study of patients with acute myocardial infarction. In over 95°o of patients antiarrhythmic therapy was not given until the onset of ventricular tachycardia, ventricular fibrillation, or persistent idioventricular rhythm. There was a mortality of 18%y during the patients' stay in hospital. The most important features of ventricular ectopic activity, which preceded these severe ventricular arrhythmias in the first 48 hr, were multiformity, variation of coupling intervals of >01 sec, the R-on-T phenomenon, double ventricular extrasystoles and ventricular bigeminy. The number of single ventricular extrasystoles per minute was related to the probability of these severe ventricular arrhythmias but to a lesser degree. It was found that if all the patients with the first two prognostic features were removed, the number of single ventricular extrasystoles was not of significant import and the other features were less important.Three-quarters of the severe arrhythmias occurred in the first 24 hr and during this period 60%y were preceded by either multiform ventricular extrasystoles or extrasystoles with variable coupling. The importance of these findings in relation to prophylactic therapy is discussed.

Cardiac Arrhythmias Triggered by Sudden and Dynamic Efforts

“…Our results showed that, although the majority of arrhythmias, in both procedures, were not accompanied by hemodynamic instability, 29 subjects in CPET and four during 4sET showed polymorphic VE. This type of arrhythmia has been linked to a rather unfavorable prognosis involving impaired ventricular function and cardiac electrical instability, which may precede the appearance of more complex ventricular arrhythmias 14–16 …”