MARKERS OF ELECTRICAL INSTABILITY IN ASSESSMENT OF CORONARY REPERFUSION IN ST ELEVATION MYOCARDIAL INFARCTION

Abstract

Aim. Assessment of the reperfusion arrhythmias, parameters of myocardial electrical instability in patients at first day of ST elevation myocardial infarction (STEMI) after pharmacoinvasive reperfusion, and analysis of the arrhythmias according to the timing of revascularization and localization of infarction. Material and methods. Totally, 130 patients studied, at the 1st day of STEMI, after pharmacoinvasive reperfusion. Patients underwent 24-hour telemetric registration of ECG in 12 leads with the complex “Astrocard-Telemetry” (ZAO “Meditek”, Russia). The analysis of ventricular arrhythmias was done, of the heart rhythm turbulence (HRT), of delayed ventricular potentials (DVP), dispersion, standard deviation of dispersion and duration of QT by the end of T wave and by its peak. Results. The more benign absolute values of independent turbulence onset (TO) are revealed (p<0,001) and turbulence slope (TS) (p<0,05), as lower number of patients with pathological HRT in the group of inferior STEMI. Among patients after anterior STEMI there was more often DVP (p<0,05), as higher values of QTе disp, QTa disp, sd QTе, sd QТa (р<0,001). It is found that delayed revascularization is associated with worse TO values (p<0,05) and TS (p<0,001). A tendency revealed towards the increase of Qte by all time intervals (p<0,05) in patients with earlier performed reperfusion. Conclusion. Delayed restoring of coronary flow makes it to register pathological HRT which represents the disordered vegetative regulation of cardiac function and points on electrical heterogeneity of myocardium. Anterior STEMI due to its size determines the disorders of electrical processes in cardiac muscle, which presents itself as DVP, adverse DVP values and increase of QTe disp, QTa disp, sd QTе and sd QТa.