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European Heart Journal 2001 22(20):1931-1937; doi:10.1053/euhj.2001.2628
Copyright © 2001 by the European Society of Cardiology.
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Influence of residual myocardial ischaemia on induced ventricular arrhythmias following a first acute myocardial infarction

F. Paganellia,f1, P. Barnaya, I. Imbert-Joschtb, R. Gelissea, A. Saadjiana, O. Mundlerb and S. Lévya

a Division of Cardiology, Hospital Nord, University of Marseilles, School of Medicine, France
b Division of Nuclear Medicine, Hospital Timone, University of Marseilles, School of Medicine, France

revised January 30, 2001; accepted January 31, 2001

Abstract

Objectives The purpose of this study was to assess the possible effect of residual myocardial ischaemia on induced ventricular arrhythmia during programmed ventricular stimulation in survivors of a first acute myocardial infarction.

Background Most deaths after hospital discharge for acute myocardial infarction are sudden and presumably arrhythmic. Sudden cardiac death results from a dynamic interaction of structural abnormalities and transient triggering factors. The role of myocardial ischaemia as a trigger for ventricular arrhythmias remains unclear. We hypothesized that residual myocardial ischaemia after a first acute myocardial infarction is a potent trigger for sustained ventricular tachyarrhythmias, particularly in the presence of an abnormal myocardium.

Methods and Results In this prospective study, programmed electrical stimulation, coronary angiography and dipyridamole-thallium-201 scintigraphy single-photon emission computed tomography were performed in 90 consecutive survivors of a first acute myocardial infarction. Patients, divided in two groups—group 1 with induced ventricular tachyarrhythmia (n=24) and group 2 without induced ventricular tachyarrhythmia (n=66)—were compared regarding residual myocardial ischaemia. The two groups were comparable in terms of mean left ventricular ejection fraction, infarct size and location, gender ratio, peak creatine kinase value, and extent of coronary disease. Residual myocardial ischaemia was detected in 32 patients: 15 (42·5%) belonged to group 1 and 17 (25·7%) to group 2. There was a statistically significant difference between the two groups regarding the presence and the extent of residual myocardial ischaemia (P<0·05).

Conclusion Residual myocardial ischaemia, revealed by dipyridamole-thallium-201 scintigraphy following a first acute myocardial infarction, might contribute to electrical instability evaluated by programmed ventricular stimulation.

Key Words: Induced ventricular arrhythmias, residual myocardial ischaemia

f1 Correspondence: Dr Franck Paganelli, MD, Cardiology Department, Hôpital Nord, Chemin des Bourrely, 13915, Marseilles Cedex 20, France.

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