Author + information
- Received October 29, 1985
- Revision received May 14, 1986
- Accepted May 27, 1986
- Published online November 1, 1986.
- Pedro Brugada, MD*,1,
- Bernd Waldecker, MD1,
- Yvo Kersschot, MD1,
- Manfred Zehender, MD1 and
- Hein J.J. Wellens, MD, FACC1
- ↵*Address for reprints: Pedro Brugada, MD, Clinical Electrophysiology Laboratory, Department of Cardiology, Academic Hospital, University of Limburg, Maastricht, The Netherlands.
Programmed electrical stimulation of the heart was prospectively used in 160 patients with healed myocardial infarction to study the incidence and characteristics of ventricular arrhythmias induced. Thirty-five patients had neither documented nor suspected ventricular arrhythmias (Group A); 37 patients had documented nonsus-tained ventricular tachycardia (Group B); 31 patients had been resuscitated from ventricular fibrillation (Group C); and 57 patients had documented sustained mono-morphic ventricular tachycardia (Group D). No electrophysiologic differences were found between patients in Group A and Group B, but patients in both groups differed significantly from patients in Group C and Group D. In the last two groups, sustained monomorphic ventricular tachycardia was more frequently induced, the cycle length of the induced ventricular tachycardia was slower and a lesser number of premature stimuli was required for induction. No differences were found in the incidence, rate or mode of induction of nonsustained monomorphic ventricular tachycardia, but nonsustained polymorphic ventricular tachycardia and ventricular fibrillation were more frequently induced in Groups A and B.
It is concluded that the substrate for sustained ventricular arrhythmia is present in at least 42% of patients after myocardial infarction. The electrophysiologic characteristics of the substrate for ventricular tachycardia seem to be the major determinant of the clinical occurrence of sustained ventricular arrhythmia. Changes in the electrophysiologic properties of the substrate of ventricular tachycardia, either spontaneously with time or induced by ischemia or antiarrhythmic drugs, can contribute to the clinical occurrence of sustained ventricular arrhythmias in patients with an old myocardial infarction.
- Received October 29, 1985.
- Revision received May 14, 1986.
- Accepted May 27, 1986.
- American College of Cardiology Foundation