PROGRESSION AND PREDICTORS OF LONGQTERM ARRHYTHMIC EVENTS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION COMPLICATED BY EARLY VENTRICULAR TACHYARRHYTHMIAS

The aim of this retrospective study was to evaluate the dynamics of left ventricular (LV) ejection fraction (EF) and end diastolic volume  (EDV) within one year after acute myocardial infarction (AMI) in  patients with early and long term sustained ventricular arrhythmias  (VA); to identify the predictors of these arrhythmias; and to  elucidate the relationships between VA, severity of coronary artery  (CA) lesions, and parameters of LV systolic function. The study  included 36 patients (33 men) aged 57.7±9.8 years with AMI  complicated by early episodes of primary ventricular fibrillation (VF)  or monomorphic ventricular tachycardia (VT). Patients were divided  into two groups depending on whether they developed long term VA  within one year after AMI. In the VA group, there was a trend to an  increase in EF and EDV. In the study group, changes in EF were not present, but EDV decreased by 30 mL relative to the baseline value. Correlation analysis did not show any associations of the number  and the time of long term VA occurrence with LV EF and EDV. The  degree of correlation between VA dynamics and CA lesion severity  was very high. The number of diseased CAs strongly correlated with  the number of VA episodes (r=0.93; p=0.003) as well as with the  time of the first arrhythmic episode onset (r=–0.83; p=0.039).  Revascularization completeness correlated with the number of  episodes (r=–0.83, p=0.009). Predictors of long term VA after AMI,  complicated by early arrhythmic episodes, comprised LV aneurysm, NSTEMI, type 2 diabetes, EDV, and EF≤35%. Left ventricular  aneurysm was an independent predictor of both long term VA and  early VT.

1. Гарганеева А.А., Округин С.А., Ефимова Е.В. и др. “Регистр острого инфаркта миокарда” как информационная популяционная система оценки эпидемиологической ситуации и медицинской помощи больным острым инфарктом миокарда // Сердце. – 2013. – № 12. – С. 37–41.

2. Марков В.А., Вышлов Е.В., Севастьянова Д.С. и др. Сравнительная эффективность фармакоинвазивной стратегии реперфузии миокарда и первичной ангиопластики у больных острым инфарктом миокарда с подъемом сегмента ST // Кардиология. – 2013. – № 10. – C. 10–15.

3. Hatzinikolaou Kotsakou E., Tziakas D., Hotidis A. et al. Could sustained monomorphic ventricular tachycardia in the early phase of a prime acute myocardial infarction affect patient outcome? // J. Electrocardiol. – 2007. – Vol. 40. – P. 72–77.

4. Mehta H. et al. Incidence of and outcomes associated with ventricular tachycardia or fibrillation in patient undergoing primary percutaneous coronary intervention // JAMA. – 2009. – Vol. 301. – P. 17–25.

5. Mont L., Cinca J., Blanch P. et al. Predisposing factors and prognostic value of sustained monomorphic ventricular tachycardia in the early phase of acute myocardial infarction // J. Am. Coll. Cardiol. – 1996. – Vol. 28. – P. 1670–1676.

6. Piccini J.P. et al. Sustained ventricular tachycardia and ventricular fibrillation complicating non ST segment elevation acute coronary syndromes // Circulation. – 2012. – Vol. 126. – P. 41– 49.

7. Russo A.M. et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter defibrillators and cardiac resynchronization therapy // Heart Rhythm. – 2013. – Vol. 10, No. 4. – P. e11–e58.

8. Silvia G. Priori et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death // Eur. Heart J. – 2015. – Vol. 36. – P. 2793–2867.

9. Wulfran Bougouin et al. Incidence of sudden cardiac death after ventricular ыbrillation complicating acute myocardial infarction: a 5 year cause of death analysis of the FAST MI 2005 registry // Eur. Heart J. – 2014. – Vol. 35. – P. 116–122.