Abstract
Ventricular tachycardia (VT) may explain syncope after myocardial infarction (MI) and is in this case is associated with a high risk of sudden death, mainly in association with low left ventricular ejection fraction (LVEF). Programmed ventricular stimulation (PVS) remains the main method to look for VT. The purpose of the study was to look for the changes of the population referred for PVS for unexplained syncope after MI during the last 26 years. 346 patients were recruited for unexplained syncope after MI between 1982 and 2008: 76 patients (group I) were studied between 1982 and 1989; 151 patients (group II) were studied between 1990 and 1999 and 119 patients (group III) were studied between 2000 and 2008. ECG and 24 hour Holter monitoring did not indicate a possible cause of syncope. LVEF was evaluated in all patients by echocardiography. PVS was systematic with the same protocol (up to 3 extrastimuli in 2 sites of right ventricle). Clinical and electrophysiological data were similar between groups I and II but differed significantly in group III: age was higher in group III (68±12 years) than in group I (64±11) and II (65±12) (p <0.009); LVEF was higher in group III (45±13%) than in group I (41±16) and II (42±13) (p<0.008). PVS was more frequently negative in group III (74%) than in group I (43%) and II (54%) (p<0.001). Monomorphic VT < 270 b/min was less frequently induced in group III (16%) than in group I (30%) and II (26%) (p<0.01). Ventricular flutter (VT > 270/min) and ventricular fibrillation were less frequently induced in group III (9%) than in group I (26%) and II (19%) (p<0.05).The changes could be related to the ICD implantation recommendations and to recanalization of occluded coronary artery, which is systematic in recent MI since 2000 (38% in group III, 27% in groups I and II) (p <0.05). Clinical data and results of PVS in patients admitted for unexplained syncope after MI infarction were identical between 1982 and 199 and have changed since 2000; patients are older and had relatively preserved LVEF. Therefore, the induction of a ventricular tachyarrhythmia is rarer than before the year 2000.
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