CORONARY ANGIOPLASTY FOR THE CONTROL OF INTRACTABLE VENTRICULAR ARRHYTHMIA

Ventricular arrhythmias (VAs) that occur following an acute extensive anterior myocardial infarction (MI) usually respond to conventional an tiarrhythmic regimes of treatment. Rarely, the VA may prove intractabl e to therapy. This report is of three patients who presented at varyin g time frames (3 h to 10 weeks) following an anterior MI. They exhibit ed sustained monomorphic ventricular tachycardia and hemodynamic insta bility despite multiple antiarrhythmic drug therapy, intravenous magne sium, direct-current cardioversion (DCCV), overdrive pacing (in one ca se), and intra-aortic balloon counter-pulsation (IABP). Although there was no clinical evidence of continuing ischemia and although coronary angiography that was done in each case showed the infarct-related art ery (IRA) to subtend akinetic areas on left ventricular(LV) angiogram, percutaneous transluminal coronary angioplasty (PTCA) of the IRA was done in all three cases. Reestablishing patency of the IRA helped in c ontrolling the VA dramatically with average therapeutic doses of antia rrhythmic drugs. Ah three patients showed this control to have been ma intained over a follow-up period of more than 1 year, with partial imp rovement in LV function and signal-averaged electrocardiogram negative for late potentials. Thus, in patients with extensive infarction and intractable VA, PTCA of the IRA may provide control of VA even in the absence of clinical signs of active ischemia or viable muscle mass.