Stručni rad

Therapeutic Approach in Patients with Asymptomatic Nonsustained Ventricular Tachycardia after Myocardial Infarction

Dubravko Petrač
Berislav Radić
Hrvoje Pintarić
Đuro Vukosavić

Sažetak

Although nonsustained ventricular tachycardia after myocardial infarction may be associated with an increased risk of sudden cardiac death, there are no clear guidelines as to which is the most effective management of this arrhythmia. In this paper, we present our experience in the treatment of patients with asymptomatic nonsustained ventricular tachycardia, prior myocardial infarction, and left ventricular ejection fraction <40%, based on electropharmacological testing performed in 130 patients. Eighty-two of them had noninducible, and 48 inducible sustained monomorphic ventricular tachycardia. Patients with noninducible ventricular tachycardia were randomized to treatment with no antiarrhythmogenic drugs (n=46) or beta-blockers (n=36). Among patients with inducible ventricular tachycardia, 23 were treated with electropharmacologically guided drug therapy, and 25 with drugs slowing inducible ventricular tachycardia. During a mean follow-up period of 24 months, seven patients died suddenly, five survived cardiac arrest, and 12 suffered nonsudden death. The overall incidence of sudden cardiac death and total mortality were significantly higher in patients with inducible than in those with noninducible ventricular tachycardia. The incidence of sudden cardiac death at 2 years was 33% in patients with inducible and nonsuppressible ventricular tachycardia, 7% in patients with inducible and electropharmacologically guided therapy, 9% in patients with noninducible ventricular tachycardia treated without drugs, and 8% in patients with noninducible ventricular tachycardia treated with beta-blockers. In conclusion, patients with asymptomatic nonsustained ventricular tachycardia, prior myocardial infarction, ejection fraction <40%, and excluded active ischemia should be submitted to electropharmacological testing. Patients with noninducible ventricular tachycardia may be followed with no drugs. Patients with inducible and suppressible ventricular tachycardia may be treated by effective drug if their ejection fraction is higher than that recorded in the Multicenter UnSustained Tachycardia Trial population. Patients with inducible and nonsuppressible ventricular tachycardia are candidates for cardioverter-defibrillator implantation, because they are at a high risk of sudden cardiac death.

Ključne riječi

Myocardial infarction, complications; Myocardial infarction, therapy; Tachycardia, ventricular, therapy

Hrčak ID:

14846

URI

https://hrcak.srce.hr/14846

Datum izdavanja:

1.3.2001.

Podaci na drugim jezicima: hrvatski

Posjeta: 1.509 *