THE CLINICAL-SIGNIFICANCE OF CORONARY ANATOMY IN POST-INFARCT PATIENTS WITH LATE SUSTAINED VENTRICULAR-TACHYCARDIA OR VENTRICULAR-FIBRILLATION

The role of ischaemia in post-infarct patients with ventricular tachya rrhythmias is not firmly established Using coronary angiography, 82 po st-infarct patients with sustained ventricular tachycardia or fibrilla tion were subclassified into three groups. Fourteen patients (17%) had significant coronary artery disease, suggesting that ischaemia was th e primary cause (group A). In 13 patients (16%) ischaemia was consider ed a coexistent factor (group B). In 55 patients (67%) ischaemia did n ot play a role (group C). The 1-year cumulative arrhythmia-free rate w as 100%, 75%, 68% and the 2-year arrhythmia-free rate 100%, 56%, 52% f or groups A, B and C, respectively. Using life-fable analysis, group A had the most favourable long-term outcome in relation to arrhythmia r ecurrence Outcomes of groups B and C were comparable. In a univariate analysis, arrhythmia recurrence was determined by the arrhythmogenic r ole of ischaemia, the left ventricular ejection fraction and the time from the old infarct to the index arrhythmia. In the absence of arrhyt hmic events in group A, multivariate analysis of groups B and C identi fied depressed ejection fractions (RR 0.69, CI 0.49-0.98) and a prolon ged time interval from the last infarct (>5 years, RR 2.53, CI 1.12-5. 75) as independent predictors for arrhythmia recurrence. The present a pproach helps in the identification of post-infarct patients with vent ricular tachycardia and fibrillation, who benefit from stand-alone ant i-ischaemic therapy. If ischaemia does not play a major arrhythmogenic role, prognosis depends on the left ventricular ejection fraction and on the age of the previous infarct. Despite adequate anti-ischaemic t herapy, prognosis remains poor if the ejection fraction is below 40% o r the infarct occurred more than 5 years before.