European Heart Journal Advance Access originally published online on November 7, 2006
European Heart Journal 2006 27(23):2906-2907; doi:10.1093/eurheartj/ehl344
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Incidence, time course, and predictors of early malignant ventricular arrhythmias after non-ST-segment elevation myocardial infarction in patients with early invasive treatment
Department of Cardiology
Coronary Care Unit
University hospital Sestre milosrdnice
Vinogradska 29
Zagreb 10000
Croatia
Tel: +385 1 3787937
Fax: +385 1 3787788
E-mail address:
vjeran.nikolic-heitzler{at}zg.htnet.hr
Department of Cardiology
Coronary Care Unit
University hospital Sestre milosrdnice
Vinogradska 29
Zagreb 10000
Croatia
We read with great interest the recent article by Rahimi et al.1 The authors investigated malignant ventricular arrhythmias requiring defibrillation (VT/VF) in patients with non-ST-elevation myocardial infarction (NSTEMI) and early percutaneous coronary intervention (PCI) (median delay of PCI was 17.5 h). The incidence of VT/VF was 2.6%, more than two-thirds occurred during the first 12 h, with a higher white blood cells count and hypokalaemia as the only predictors.
What about patients with acute ST-segment elevation myocardial infarction (STEMI) within the scope of VT/VF? Primary PCI was introduced in the therapy of those patients as a 24 h service in our center on 1 October 2000. Since then, we treated almost 700 such patients within the first 12 h after the onset of symptoms.2 According to our experience and results, patients with acute STEMI treated with primary PCI have a higher incidence of sustained ventricular tachycardia and ventricular fibrillation than quoted earlier and most of them occurred within the first 12–24 h. The affected myocardial wall, reperfusion achievement, and pain-to-balloon or door-to-balloon have no statistically significant influence on the appearance of malignant ventricular arrhythmias.3 According to the literature, in patients with acute STEMI and successful primary PCI, the only positivity of cardiac troponin T on admission seems to be associated with a higher incidence of VT/VF.4 Patients with STEMI and VT/VF after reperfusion have a higher mortality rate, but the same frequency of other major adverse cardiovascular events in comparison to those without these arrhythmias.3
This issue is very important because it is still hard to predict these life-treatening arrhythmias in individual patients with myocardial infarction, especially if good reperfusion is acheived. It still remains uncertain, when considering the pathophysiology of these arrhythmias in patients with myocardial infarction, whether these are really caused by reperfusion (coronary intervention, medicamentous, spontaneous) or ischaemia?5 Further investigations should be directed towards discovering predictors of malignant ventricular arrhythmias after reperfusion in both NSTEMI and STEMI, as well as redefining VT/VF as reperfusion arrhythmias according to pathophysiological and clinical criteria. Finally, we agree that the problem of VT/VF in patients with myocardial infarction and mechanically achieved good reperfusion becomes of lesser significance after the first 24 h, which is important from an economic point of view.
References
- Rahimi K, Watzlawek S, Thiele H, Secknus MA, Hayerizadeh BF, Niebauer J, Schuler G. (2006) Incidence, time course, and predictors of early malignant ventricular arrhythmias after non-ST-segment elevation myocardial infarction in patients with early invasive treatment. Eur Heart J 27:1706–1711.
[Abstract/Free Full Text] - Mihatov
, Nikoli-Heitzler V, Radi V, Planinc D, Pintari H, Babi Z, Manola , tambuk K, Deli-Brklja
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, Tomuli V, Petra D. (2006) Role of (reperfusion) arrhthmias in predicting outcome in patients with ST-elevation acute myocardial infarction. Neurol Croat 55:63–73. - Bonnemeier H, Wiegand UK, Giannitis E, Schulenburg S, Hartmann F, Kurowski V, Bode F, Tolg R, Katus HA, Richardt G. (2003) Temporal repolarization inhomogeneity and reperfusion arrhythmias in patients undergoing successful primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: impact of admission troponin T. Am Heart J 145:484–492.[CrossRef][ISI][Medline]
- Antman EM, Zipes DP, Libby P, Bonow RO, Braunwald E. (2005) ST-elevation myocardial infarction management. In:. Braunwald's Heart Disease. A Textbook of Cardiovascular Medicine 7th ed. (Elsevier Saunders, Philadelphia) pp. 1167–1226.
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