Copyright © 1988 by the European Society of Cardiology.
© 1988 The European Society of Cardiology
The role of collateral blood supply in ventricular tachycardia after myocardial infarcation
Department of Cardiology, University of Limburg, University Hospital Maastricht, The Netherlands
Received 23 February 1988; revised 11 April 1988; .
Address for correspondence and reprints Pedro Brugada, MD, Associate Professor University of Limburg, Director, Clinical Electrophysiology Laboratory, Department of Cardiology, University Hospital, Maastricht, The Netherlands.
Abstract
The hypothesis that collateral or anterograde blood supply to an infarcted area maintains blood supply to cells responsible for ventricular tachycardia after myocardial infarction was studied in six patients. All patients had suffered a myocardial infarction and developed spontaneous episodes of sustained monomorphic ventricular tachycardia. The arrhythmia was paroxysmal in three patients and incessant in the other three. During ventricular tachycardia iced isotonic saline (10 ml in approximately 4 s) was injected first in the coronary artery ostia and thereafter superselectively in the coronary artery providing collateral or anterograde blood supply to the infarcted area. A 2.5-F catheter was used superselectively to catheterize coronary arteries of approximately 2–3 mm lumen for that purpose. Three patients had anterograde blood supply to the infarcted area through a reperfused infarct-related vessel. Two patients had only collateral retrograde blood supply to the infarcted region. One patient had both anterograde and retrograde collateral blood supply to the area of infarction. Ventricular tachycardia was not terminated in any patient during non-selective injection of iced saline in the coronary ostia. In five of the six patients ventricular tachycardia was terminated by the super-selective administration of iced saline. The morphology of ventricular tachycardia was changed many times, but did not terminate, in the remaining patient. Termination or change in morphology was achieved during administration of iced saline through collateral vessels in two patients through the coronary artery supplying anterograde flow in three patients and both through collaterals and anterograde flow in the remaining patient. It is concluded that collaterol vessels or anterograde flow through the infarct-related vessel maintain the viability of electrically normal, but electrically badly coupled, cells responsible for ventricular tachycardia after myocardial infarction.
Key Words: Ventricular tachycardia • myocardial infarction • transcoronary termination of tachycardias • collateral blood supply
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