Prognosis following sustained ventricular tachycardia occurring early after myocardial infarction

Abstract

Eighty-seven patients with sustained ventricular tachycardia (VT) between 3 and 90 days after acute myocardial infarction (AMI) were evaluated to define factors associated with a high risk of arrhythmia recurrence or death. Most patients had poor left ventricular function (mean ejection fraction 29 ± 12%), multivessel coronary artery disease (71%) and inducible sustained VT with programmed stimulation (87%). During a mean followup of 26 months, 36 patients (41%) died and 21 patients had arrhythmia recurrence (with 19 sudden deaths). Factors independently associated With mortality included: (1) treatment before 1981 (p < 0.01); (2) anterior AMI (p < 0.05); (3) short time from AMI to first episode of VT (p < 0.06); and (4) multivessel coronary artery disease (p < 0.07). Factors independently associated with arrhythmia recurrence were: (1) medical treatment (as opposed to surgical) (p < 0.01); (2) ≥3 episodes of spontaneous VT (p = 0.01); (3) multivessel coronary disease (p < 0.05); and (4) anterior AMI (p < 0.07). Medically and surgically treated patients did not differ significantly in overall survival (49 vs 61%, respectively), although short-term (6 month) surgical survival improved from 31% during the first half of the study to 96% in the latter half (p < 0.01). For patients with sustained VT early after AMI the risk of death and arrhythmia recurrence can be assessed based on clinical and angiographic characteristics; in addition, surgical treatment is associated with a lower incidence of arrhythmia recurrence than medical treatment. Given the recent improvement in short-term surgical survival, surgery may be the preferred option for high risk patients with multivessel coronary disease and frequent episodes of VT.