Abstract
Programmed ventricular stimulation (PVS) was proposed after myocardial infarction (MI) more than 25 years ago, but the management of MI has changed during this period. The purpose of the study was to look for the results of systematic PVS after MI according to the period of indication and remaining indications. PVS was performed between 1982 and march 2010, from 4 to 8 weeks after acute MI in 797 patients (pts) without syncope or ventricular tachycardia (VT) to stratify the risk of arrhythmias: 301 (group I) were studied between 1982 and 1989, 315 (group II) between 1990 and 1999 and 179 (group III) between 2000 and 2010. PVS used the same protocol (up to 3 extrastimuli in 2 sites of right ventricle). Group III pts were older (61 ± 10 years) than group I (56 ± 11) and group II pts (58 ± 11) (p<0.002). LVEF was lower in group III (36 ± 11%) than in group I (44 ± 15) and II (41 ± 12) (p<0.05). PVS was as frequently negative in group III (58.5%) as in group I (52%) and II (47%). Monomorphic VT < 270 b/min was induced as frequently in group III (27%) as in group I (20%) and II (21.5%). Ventricular fibrillation was induced less frequently in group III (7%) than in group II (12%) and I (13%) (p<0.04). Ventricular flutter (VT > 265 b/min) was induced less frequently in group III (8%), than in group II (18%, p<0.001) and I (15%) (p < 0.03). The only significant difference was the primary angioplasty with recanalization of occluded coronary artery, more systematic since 2000: total revascularization was obtained in 39% of group III and 27% of groups II and I (p<0.05). The interpretation of PVS are now easier to interpret, because the induction of non specific arrhythmias, the ventricular flutter and fibrillation, is rarer than before 2000, although PVS was indicated in patients with lower LVEF. The decrease of the induction of this arrhythmia could be related to the more systematic indication of primary angioplasty in MI since 2000. PVS remains useful in pts with debatable indications of defibrillator to help to take a decision.
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