This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mont, L. Articles by Brugada, J. Search for Related Content PubMed PubMed Citation Articles by Mont, L. Articles by Brugada, J.

CLINICAL STUDIES

Arrhythmia recurrence in patients with a healed myocardial infarction who received an implantable defibrillator: analysis according to the clinical presentation

^a Arrhythmia Unit, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain

Manuscript received August 17, 1998; revised manuscript received March 6, 1999, accepted April 14, 1999.

Reprint requests and correspondence: Dr. Lluís Mont, Arrhythmia Unit, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
jllmont{at}medicina.ub.es

OBJECTIVES

The purpose of this study was to analyze the type of arrhythmia recurrence, based on stored electrograms, in patients with a healed myocardial infarction (MI) who received an implantable defibrillator.

BACKGROUND

Previous studies suggest that patients presenting with cardiac arrest (CA) tend to recur as ventricular fibrillation (VF), whereas those suffering sustained monomorphic ventricular tachycardia (SMVT) tend to recur as SMVT. However, these data have not been confirmed in a homogeneous population of patients with MI.

METHODS

A total of 88 patients was divided into three groups according to their clinical presentation: SMVT (n = 57), CA (n = 16) or syncope (n = 15).

RESULTS

There were no significant differences in clinical characteristics among groups. In the electrophysiologic study SMVT was induced in 93%, 94% and 80% of patients, respectively (p = NS). During the follow-up period, 52% of patients presented a total of 671 episodes of ventricular arrhythmia treated by the defibrillator. All recurrences were as SMVT except for one VF. There were 610 episodes of SMVT treated with antitachycardia pacing, with an effectiveness of 96%. A total of 61 episodes was treated initially with cardioversion. No differences in the probability of recurrence were observed among groups, although the statistical power was low (50%).

CONCLUSIONS

In patients with an old infarction and malignant ventricular arrhythmias, the majority of recurrences are due to SMVT independently of the clinical presentation (SMVT, CA or syncope) or the induced arrhythmia at the electrophysiologic study. The programming of an antitachycardia zone seems to be appropriate also for patients who present with CA or syncope.

Abbreviations and Acronyms   ATP = antitachycardia pacing   CA = cardiac arrest   ECG = electrocardiographic   EPS = electrophysiologic study   ICD = implantable cardiac defibrillator   MI = myocardial infarction   SMVT = sustained monomorphic ventricular tachycardia   VF = ventricular fibrillation   VT = ventricular tachycardia

This article has been cited by other articles:

				B. Brembilla-Perrot, C. Suty-Selton, D. Beurrier, P. Houriez, M. Nippert, A. Terrier de la Chaise, P. Louis, O. Claudon, M. Andronache, A. Abdelaah, et al. Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing J. Am. Coll. Cardiol., August 4, 2004; 44(3): 594 - 601. [Abstract] [Full Text] [PDF]

				E. Garcia-Moran, L. Mont, A. Cuesta, M. Matas, and J. Brugada Low recurrence of syncope in patients with inducible sustained ventricular tachyarrhythmias treated with an implantable cardioverter-defibrillator Eur. Heart J., June 1, 2002; 23(11): 901 - 907. [Abstract] [Full Text] [PDF]

				R.N.W. Hauer, E. Aliot, M. Block, A. Capucci, B. Luderitz, M. Santini, and P.E. Vardas Indications for implantable cardioverter defibrillator (ICD) therapy. Study Group on Guidelines on ICDs of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology Eur. Heart J., July 1, 2001; 22(13): 1074 - 1081. [PDF]

				R. N. W. Hauer, E. Aliot, M. Block, A. Capucci, B. Luderitz, M. Santini, and P. E. Vardas Indications for implantable cardioverter defibrillator (ICD) therapy: Study Group on Guidelines on ICD of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology Europace, January 1, 2001; 3(3): 169 - 176. [PDF]