Malignant Ventricular Arrhythmias in Patients With Acute Right Ventricular Infarction Undergoing Mechanical Reperfusion

Abstract

Patients with acute right ventricular (RV) infarctions are prone to ventricular arrhythmias, but little is known regarding the temporal patterns of these arrhythmias, their impact on outcomes, or their relation to the severity of RV impairment. The aim of this study was to examine the impact of malignant ventricular arrhythmias (MVAs) complicating acute RV infarction. A further aim was to determine whether the degree of RV impairment was a predisposing factor to MVAs. The charts of 48 patients with acute RV infarctions were reviewed for documented MVAs. Temporal presentation, relating to reperfusion, and in-hospital outcomes were tabulated. Echocardiograms were reviewed to quantify RV impairment. MVAs occurred in 38% of patients, with multiple episodes (electrical storm) in 8.3%. MVAs developed before reperfusion (72% of patients), abruptly with reperfusion (11%), or after reperfusion (22%). Patients with MVAs had larger infarcts (peak creatine phosphokinase 3,027 vs 1,848 U/L, p = 0.03) and trended toward worse RV function (fractional shortening 27% vs 34%, p = 0.08). In-hospital mortality (patients with MVAs 17% vs 6.7%, p = 0.35), intensive care days (patients with MVAs 7.1 +/- 10 vs 3.9 +/- 2.5, p = 0.39), and hospital days (patients with MVAs 10.3 +/- 10 vs 8.0 +/- 5.1, p = 0.57) were similar between groups. Patients with electrical storm had longer intensive care stays (18.0 +/- 18.5 vs 4.0 +/- 2.5 days, p = 0.02) and hospital stays (20.5 +/- 17 vs 7.9 +/- 5.0 days, p = 0.05). In conclusion, MVAs are common in acute RV infarctions. They frequently occur before reperfusion and are associated with larger infarcts. With reperfusion, MVAs had little impact on intensive care and hospital stays or in-hospital mortality, except in patients with electrical storm.