Document Detail

Electrocardiographic factors playing a role in ischemic ventricular fibrillation in ST elevation myocardial infarction are related to the culprit artery.
MedLine Citation:
PMID:  18180022     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Sudden cardiac death caused by ischemic ventricular fibrillation (VF) associated with ST elevation myocardial infarction (STEMI) is one of the most frequent causes of death. OBJECTIVE: We hypothesized that electrocardiographic (ECG) characteristics differ between STEMI patients with and without ischemic VF. METHODS: Fifty-five first STEMI patients with at least one 12-lead ECG recorded before ischemic VF were compared with 110 first STEMI patients without ischemic VF. Patients with bundle branch blocks or high-degree atrioventricular blocks with escape rhythms were not included. ECG measurements were performed manually after scanning the ECG with the most prominent ST deviation into a software environment and magnifying it 4 times. RESULTS: Mean age was 57 +/- 12 years, and 126 patients were male. No differences were present between the VF and control group regarding baseline, enzymatic, and angiographic data. In left circumflex artery and right coronary artery myocardial infarction, a longer QRS interval (109 +/- 23 ms vs. 91 +/- 16 ms, P = .02 and 107 +/- 24 ms vs. 93 +/- 19, P = .02) was present. In the latter the PR interval (211 +/- 64 ms vs. 160 +/- 36 ms, P <.001) and ST deviation score (3.6 +/- 1.0 mV vs. 1.7 +/- 1.5 mV, P <.001) were also increased. In the left anterior descending artery group no differences in conduction intervals and ST deviation score were present. CONCLUSION: Longer PR and QRS intervals in right coronary artery and left circumflex artery MI fit with the perfusion and activation pattern of the atrioventricular node and the ventricular myocardium. Myocardium perfused by the left anterior descending artery is activated earliest, hiding any intraventricular conduction delay within the QRS complex. Intramural slowed conduction could be a substrate for ischemic VF.
Miguel E Lemmert; Jonas S S G de Jong; Antonius M W van Stipdonk; Harry J G M Crijns; Hein J J Wellens; Mitchell W Krucoff; Lukas R Dekker; Arthur A M Wilde; Anton P M Gorgels
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-09-19
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  5     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-08     Completed Date:  2008-05-07     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  71-8     Citation Subset:  IM    
Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands.
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MeSH Terms
Case-Control Studies
Coronary Vessels / pathology*,  physiopathology
Heart Conduction System / physiology*
Middle Aged
Myocardial Infarction / physiopathology*
Myocardial Ischemia / complications*,  physiopathology
Retrospective Studies
Tachycardia / physiopathology
Ventricular Fibrillation / etiology*,  physiopathology
Erratum In:
Heart Rhythm. 2008 May;5(5):773

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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