Document Detail


Coronary artery revascularization in patients with sustained ventricular arrhythmias in the chronic phase of a myocardial infarction: effects on the electrophysiologic substrate and outcome.
MedLine Citation:
PMID:  11216974     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The objective of this study was to analyze the influence of coronary artery revascularization in patients with ventricular arrhythmias. BACKGROUND: Coronary artery revascularization is an effective treatment for myocardial ischemia; however, its effect on ventricular arrhythmias not related to an acute ischemic event has not been carefully studied. METHODS: Sixty-four patients (58 men, mean age 65 +/- 8 years old) with prior myocardial infarction, spontaneous ventricular arrhythmias not related to an acute ischemic event (55 ventricular tachycardia, 9 ventricular fibrillation) and coronary lesions requiring revascularization were studied prospectively. Electrophysiological study was performed before and after revascularization, and events during follow-up were analyzed. RESULTS: At initial study 61 patients were inducible into sustained ventricular arrhythmias. After revascularization, in 62 survivors, 52 out of 59 patients previously inducible were still inducible (group A), and 10 patients were noninducible (group B). No differences were found in clinical, hemodynamic, therapeutic and electrophysiological characteristics between both groups. During 32 +/- 26 months follow-up, 28/52 patients in group A (54%) and 4/10 patients in group B (40%) had arrhythmic events (p = 0.46). An ejection fraction <30% predicted recurrent arrhythmic events (p = 0.02), but not the presence of demonstrable ischemia before revascularization (p = 0.42), amiodarone (p = 0.69) or beta-adrenergic blocking agent therapy (p = 0.53). Total mortality was 10% in both groups. CONCLUSIONS: In patients with ventricular arrhythmias in the chronic phase of myocardial infarction, probability of recurrence is high despite coronary artery revascularization, but mortality is low if combined with appropriate antiarrhythmic therapy. Recurrences are related to the presence of a low ejection fraction but not to demonstrable ischemia before revascularization, amiodarone or beta-blocker therapy nor are they the results of electrophysiological testing after revascularization.
Authors:
J Brugada; L Aguinaga; L Mont; A Betriu; J Mulet; G Sanz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  37     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-02-16     Completed Date:  2001-03-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  529-33     Citation Subset:  AIM; IM    
Affiliation:
Arrhythmia Section, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain. jbrugada@medicina.ub.es
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Disease / mortality,  physiopathology,  therapy*
Electrocardiography*
Female
Humans
Length of Stay
Male
Middle Aged
Myocardial Infarction / mortality,  physiopathology,  therapy*
Myocardial Revascularization*
Postoperative Complications / mortality,  physiopathology*
Prognosis
Recurrence
Stroke Volume / physiology*
Survival Rate
Tachycardia, Ventricular / mortality,  physiopathology,  therapy*
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2001 Oct;38(4):1268-9   [PMID:  11587029 ]

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