Sustained ventricular tachyarrhythmias within 2 months of acute myocardial infarction: Results of medical and surgical therapy in patients resuscitated from the initial episode

John P. DiMarco, Bruce B. Lerman, Irving L. Kron, T. Duncan Sellers

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Sustained ventricular tachycardia or fibrillation that develops during the early recovery period after acute myocardial infarction is a common clinical problem whose management remains controversial. Fifty-three patients who survived an initial episode of sustained ventricular tachycardia or fibrillation occurring between 3 and 60 days (mean ± SD 21 ± 16) after myocardial infarction were evaluated. Most of these patients had had a large (peak creatine kinase = 1,729 ± $82 IU) complicated infarction. Forty-two (79%) of the 53 patients had had repetitive sustained ventricular arrhythmias and the condition of 19 of these could not be stabilized with drug therapy. Twenty-eight patients received medical therapy only. Twenty-four survived and were discharged from the hospital. Twenty-five patients underwent infarctectomy or aneurysmectomy either on an emergency basis (16 patients) or electively because of coexistent heart failure orangina (9 patients). Intraoperative mapping was attempted in these patients but was completely successful in only 13 (52%). Operative mortality was 16% with all deaths occurring in patients who were in shock before surgery. Five of 21 surgically treated survivors required long-term antiarrhythmic therapy. Twenty-one of 24 patients medically treated remain alive and well after 15 ± 10 months of follow-up. Nineteen of 21 surgically treated patients remain alive and well after 17.9 ± 11 months. One of these patients required reoperation for severe mitral regurgitation. These results confirm the poor medical prognosis of sustained ventricular tachyarrhythmias that present during the first 2 months after myocardial infarction but demonstrate that an acceptable rate of survival can be achieved with a combined medical and surgical approach to therapy.

Original languageEnglish (US)
Pages (from-to)759-768
Number of pages10
JournalJournal of the American College of Cardiology
Volume6
Issue number4
DOIs
StatePublished - Jan 1 1985
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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