Jay B Thakkar1, Sarah Zaman1, Karen Byth1, Arun Narayan1, Aravinda Thiagalingam1, Clara Chow1, Stuart P Thomas1, Gopal Sivagangabalan1, David Farlow1, Robert Barnett1, Pramesh Kovoor2. 1. From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.). 2. From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.). pramesh.kovoor@sydney.edu.au.
Abstract
BACKGROUND: Inducible ventricular tachycardia (VT) is a strong predictor of spontaneous ventricular tachyarrhythmia following ST-segment-elevation myocardial infarction. Reduced left ventricular ejection fraction (EF) predisposes patients to inducible VT after ST-segment-elevation myocardial infarction. However, the role of right ventricular (RV) dysfunction in predisposing to inducible VT has not been described previously. METHODS AND RESULTS: Consecutive patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention underwent predischarge radionuclide gated heart pool scan to assess ventricular EF. The study cohort included patients with reduced left ventricular EF (left ventricular EF ≤40%) who underwent electrophysiology study (n=220) in an attempt to induce VT. We defined RV dysfunction as RVEF ≤35%. The end point was sustained monomorphic VT (cycle length ≥200 ms). This was considered a positive study. No inducible arrhythmia, ventricular fibrillation, or flutter (cycle length <200 ms) was considered a negative study. Infarct region, infarct-related artery, male sex, and RVEF ≤35% were univariable predictors of positive test. After multivariable analysis, RVEF ≤35% had the strongest association as an independent predictor of inducible VT at electrophysiology study (P<0.001; odds ratio, 5.8; 95% confidence interval, 3.005-11.262). CONCLUSIONS: RV dysfunction (RVEF ≤35%) predisposed to inducible VT at electrophysiology study in patients with impaired left ventricular EF (≤40%) after acute ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention.
BACKGROUND: Inducible ventricular tachycardia (VT) is a strong predictor of spontaneous ventricular tachyarrhythmia following ST-segment-elevation myocardial infarction. Reduced left ventricular ejection fraction (EF) predisposes patients to inducible VT after ST-segment-elevation myocardial infarction. However, the role of right ventricular (RV) dysfunction in predisposing to inducible VT has not been described previously. METHODS AND RESULTS: Consecutive patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention underwent predischarge radionuclide gated heart pool scan to assess ventricular EF. The study cohort included patients with reduced left ventricular EF (left ventricular EF ≤40%) who underwent electrophysiology study (n=220) in an attempt to induce VT. We defined RV dysfunction as RVEF ≤35%. The end point was sustained monomorphic VT (cycle length ≥200 ms). This was considered a positive study. No inducible arrhythmia, ventricular fibrillation, or flutter (cycle length <200 ms) was considered a negative study. Infarct region, infarct-related artery, male sex, and RVEF ≤35% were univariable predictors of positive test. After multivariable analysis, RVEF ≤35% had the strongest association as an independent predictor of inducible VT at electrophysiology study (P<0.001; odds ratio, 5.8; 95% confidence interval, 3.005-11.262). CONCLUSIONS:RV dysfunction (RVEF ≤35%) predisposed to inducible VT at electrophysiology study in patients with impaired left ventricular EF (≤40%) after acute ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention.
Authors: Roman Y Medvedev; Jose L Sanchez-Alonso; Catherine A Mansfield; Aleksandra Judina; Alice J Francis; Christina Pagiatakis; Natalia Trayanova; Alexey V Glukhov; Michele Miragoli; Giuseppe Faggian; Julia Gorelik Journal: Sci Rep Date: 2021-03-01 Impact factor: 4.996