부산대학교 도서관

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0735-1097(99)00206-5 Byline: LluiIs Mont (a), Mariana Valentino (a), Antonia Sambola (a), Mariona Matas (a), Luis Aguinaga (a), Josep Brugada (a) Abbreviations: ATP, antitachycardia pacing; CA, cardiac arrest; ECG, electrocardiographic; EPS, electrophysiologic study; ICD, implantable cardiac defibrillator; MI, myocardial infarction; SMVT, sustained monomorphic ventricular tachycardia; VF, ventricular fibrillation; VT, ventricular tachycardia Abstract: OBJECTIVES The purpose of this study was to analyze the type of arrhythmia recurrence, based on stored electrograms, in patients with a healed myocardial infarction (MI) who received an implantable defibrillator. BACKGROUND Previous studies suggest that patients presenting with cardiac arrest (CA) tend to recur as ventricular fibrillation (VF), whereas those suffering sustained monomorphic ventricular tachycardia (SMVT) tend to recur as SMVT. However, these data have not been confirmed in a homogeneous population of patients with MI. METHODS A total of 88 patients was divided into three groups according to their clinical presentation: SMVT (n = 57), CA (n = 16) or syncope (n = 15). RESULTS There were no significant differences in clinical characteristics among groups. In the electrophysiologic study SMVT was induced in 93%, 94% and 80% of patients, respectively (p = NS). During the follow-up period, 52% of patients presented a total of 671 episodes of ventricular arrhythmia treated by the defibrillator. All recurrences were as SMVT except for one VF. There were 610 episodes of SMVT treated with antitachycardia pacing, with an effectiveness of 96%. A total of 61 episodes was treated initially with cardioversion. No differences in the probability of recurrence were observed among groups, although the statistical power was low (50%). CONCLUSIONS In patients with an old infarction and malignant ventricular arrhythmias, the majority of recurrences are due to SMVT independently of the clinical presentation (SMVT, CA or syncope) or the induced arrhythmia at the electrophysiologic study. The programming of an antitachycardia zone seems to be appropriate also for patients who present with CA or syncope. Author Affiliation: (a) Arrhythmia Unit, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain Article History: Received 17 August 1998; Revised 6 March 1999; Accepted 14 April 1999