ASSOCIATION OF VENTRICULAR ARRHYTHMIAS WITH LEFT-VENTRICULAR REMODELING AFTER MYOCARDIAL-INFARCTION

Objective-To assess the relation between ventricular arrhythmias after myocardial infarction and left ventricular remodelling. Design-Prospe ctive study with consecutive patients. Methods-97 patients with acute myocardial infarction underwent serial echocardiographic examinations (days 1, 2, 3, and 7, and after 3 weeks) to determine end diastolic vo lume, end systolic volume, and ejection fraction; volumes were normali sed for body surface area and expressed as indices. Holter monitoring was performed on the day of the final echocardiogram. Coronary angiogr aphy was performed in 88 patients before hospital discharge. Results-C omplex ventricular arrhythmias (defined as Lown class 3-5) were found in 16 of 97 patients. In logistic regression models, variables predict ive of complex ventricular arrhythmias were end systolic volume index on admission (b = 0.054, P = 0.015) and end diastolic volume index aft er three weeks (b = 0.034, P = 0.012). Complex arrhythmias were also r elated to the increase of end diastolic and end systolic volume indice s throughout the study (F = 5.62, P = 0.046 and F = 6.42, P = 0.017, r espectively by MANOVA). A two stage linear regression model of ventric ular volume versus time from infarct showed that both intercept (initi al volume) and slope (rate of increase) were higher for patients with complex arrhythmias in both diastole and systole (P < 0.001 for all). Conclusions-Complex ventricular arrhythmias after myocardial infarctio n are related to the increase of left ventricular volume rather than t o depressed ejection fraction. Complex arrhythmias may be an aetiologi cal factor linking left ventricular remodelling with higher mortality, but larger follow up studies of patients with progressive left ventri cular dilatation after myocardial infarction are necessary to answer t hese questions.