Coronary artery revascularization in patients with sustained ventricular arrhythmias in the chronic phase of a myocardial infarction: Effects on the electrophysiologic substrate and outcome

OBJECTIVES The objective of this study was to analyze the influence of coro nary artery revascularization in patients with ventricular arrhythmias. BACKGROUND Coronary artery revascularization is an effective treatment for myocardial ischemia; however, its effect on ventricular arrhythmias not rel ated to an acute ischemic event has not been carefully studied. METHODS Sixty-four patients (58 men, mean age 65 +/- 8 years old) with prio r myocardial infarction, spontaneous ventricular arrhythmias not related to an acute ischemic event (55 ventricular tachycardia, 9 ventricular fibrill ation) and coronary lesions requiring revascularization were studied prospe ctively. Electrophysiological study was performed before and after revascul arization, and events during follow-up were analyzed. RESULTS At initial study 61 patients were inducible into sustained ventricu lar arrhythmias. After revascularization, in 62 survivors, 52 out of 59 pat ients previously inducible were still inducible (group A), and 10 patients were noninducible (group B). No differences were found in clinical, hemodyn amic, therapeutic and electrophysiological characteristics between both gro ups. During 32 +/- 26 months follow-up, 28/52 patients in group A (54%) and 4/10 patients in group B (40%) had arrhythmic events (p = 0.46). An ejecti on fraction <30% predicted recurrent arrhythmic events (p = 0.02), but not the presence of demonstrable ischemia before revascularization (p = 0.42), amiodarone (p = 0.69) or beta-adrenergic blocking agent therapy (p = 0.53). Total mortality was 10% in both groups. CONCLUSIONS In patients with ventricular arrhythmias in the chronic phase o f myocardial infarction, probability of recurrence is high despite coronary artery revascularization, but mortality is low if combined with appropriat e antiarrhythmic therapy. Recurrences are related to the presence of a low ejection fraction but not to demonstrable ischemia before revascularization , amiodarone or beta-blocker therapy nor are they the results of electrophy siological testing after revascularization. (J Am Cell Cardiol 2001;37:529- 33) (C) 2001 by the American College of Cardiology.