Prediction of ventricular arrhythmias and sudden cardiac death after myocardial infarction

Akut miyokard infarktüsü sonrası gelişen ventriküler aritmi ve ani ölüm riskinin araştırılması

Bayram KORKUT,Hasan GÖK,Gülay KORKMAZ,Mehmet TOKAÇ,Mustafa DEMİRKIRAN,H. Hüseyin TELLİ

Abstract

Prediction of ventricular arrhythmias and sud¬den cardiac death after myocardial infarction In order to stratificate the risk of arrhythmic events (AE) such as sudden cardiac death, vent¬ricular fibrillation, sustained vertricular tach¬ycardia in the first year after myocardial infarction, 62 patients were evaluated with echocardiography, Holter monitorisation and high resolution signal averaged electrocardiography (HI-RES ECG). Patients were divided into 2 subgroups according to presence or absence of AE [AE (+): 5 (%8), AE (-): 57 (%92)]. Patients with AE [(mean left ventricular ejection fraction (LVEF): % 48±13.5 showed 5 (%100) late potentials (LP), 1 (%20) malign VA and 3 (%60) LV dysfunction with LVEF < %40, while the other patients with AE (-) (LVEF % 55+9.7) had 28 (49%) LP (+), 2(%3.5) malign VA ve 7 (%I2) LVEF<%40 (p<0.05, p>0.05, p<0.01). During the 1 ' year follow-up, LP (+) patients (n=33) who had 6 (18%) LVEF<%40 and 3(%9) malign VA showed 5 (%15) sudden death, while LP (-) patients (n=29) who had 4 (13.8%) VEF<%40 but no malign VA, showed no sudden death (p>0.05, p>0.05, p<0.05). Patients with VA (n=14) who had 11(%78.5) LP (+) and 5J%35.7) LVEF<40 showed 4 (%28.5) sud¬den death in the first year after AMI, whereas pa¬tients without VA (n=48) who had 22 (%45.8) LP (+) and 5(%10) LVEF<%40 showed 1 (2%) sudden death (p<0.05, p<0.05, p<0.01). Patients with LVEF<%40 (n=10), who had 6 (%60) LP (+) and 1 (%10) malign VA before hospital discharge evolved 3 (%30) sudden death, whereas pa¬tients with LVEF>%40 (n=52) who had 27 (%51.9) LP (+) and 2 (%3.8) malign VA before hospital disc¬harge, showed 2 (%3.8) sudden death in the one year follow-up period (p>0.05, p>0.05, p<0.0I). In conclusion, in the risk stratification of arrhy¬thmic events after AMI, all of the three methods (ec¬hocardiography, Holter, HI-RES ECG) are useful where HI-RES ECG is more sensitive.

Özet

Akut miyokard infarktüsü (AMI) geçiren 62 olgu hastaneden çıkmadan önce ekokardiyogra.fi, ■ Holter monitor . ve sinyal ortalamak elektrokardiyografi (SOEKG) ile incelendi. Bir yıllık takip süresi içinde aritmi olayı (AO) (ani ölüm, ventriküler fibrilasyon, sürekli ventriküler taşikardi) yönünden değerlendirildi. ' AMI geçiren olgular, AO (+) [5 (%8)] ve AO (-) [57 (%92)] gruplara ayrıldı. AO (+) grubun [sol ventrikül ejeksiyon fraksiyonu (LVEF): % 48+13.5 mmHg] tümünde (% 100) geç potansiyel (LP) po¬zitifliği, I 'inde (%20) malign ventriküler aritmi (VA) 3 olguda (%60) LVEF 0.05, p 0.05, p>0.05, p %40 olan ve-27 olguda (%51.9) LP (+), 2 olguda (%3.8) malign VA tesbit edilen 52 ol¬gunun bir yıllık takibinde 2 tanesinde, (%3.8) ani ölüm gelişti (p>0.05, p>0.05, p<0.01). Sonuç olarak AMI sonrası malign VA ve ani ölüm riskinin belirlenmesinde en fazla SOEKG olmak üzere 3 yöntemin de (SOEKG, eko-kardiyogra.fi, Holter monitor) faydalı olabileceği ka¬naatine varıldı.