Ventricular arrhythmia burst is an independent indicator of larger infarct size even in optimal reperfusion in STEMI

Kirian van der Weg; Mohamed Majidi; Joost D E Haeck; Jan G P Tijssen; Cynthia L Green; Karel T Koch; Wichert J Kuijt; Mitchell W Krucoff; Anton P M Gorgels; Robbert J de Winter

doi:10.1016/j.jelectrocard.2016.03.013

Ventricular arrhythmia burst is an independent indicator of larger infarct size even in optimal reperfusion in STEMI

J Electrocardiol. 2016 May-Jun;49(3):345-52. doi: 10.1016/j.jelectrocard.2016.03.013. Epub 2016 Mar 8.

Affiliations

¹ Maastricht University Medical Center, Maastricht, The Netherlands; Duke University Medical center and Duke Clinical Research Institute, Durham, USA. Electronic address: [email protected].
² Maastricht University Medical Center, Maastricht, The Netherlands; Duke University Medical center and Duke Clinical Research Institute, Durham, USA.
³ Academic Medical Center, Amsterdam, The Netherlands.
⁴ Duke University Medical center and Duke Clinical Research Institute, Durham, USA.
⁵ Maastricht University Medical Center, Maastricht, The Netherlands.

PMID: 27034119
DOI: 10.1016/j.jelectrocard.2016.03.013

Abstract

Objective: We hypothesized that ventricular arrhythmia (VA) bursts during reperfusion phase are a marker of larger infarct size despite optimal epicardial and microvascular perfusion.

Methods: 126 STEMI patients were studied with 24h continuous, 12-lead Holter monitoring. Myocardial blush grade (MBG) was determined and VA bursts were identified against subject-specific background VA rates in core laboratories. Delayed-enhancement cardiovascular magnetic resonance imaging was used to determine infarct size.

Results: In the group with MBG 3 no significant differences were found for baseline characteristics between burst versus no burst (102 vs. 24). In those with optimal epicardial and microvascular reperfusion (TIMI 3, stable ST-recovery, and MBG 3), VA burst was associated with larger infarct size (N=102/126; median 11.0 vs. 5.1%; p=0.004).

Conclusion: In the event of MBG 3, VA bursts were associated with significantly larger infarct size even if optimal epicardial and microvascular reperfusion was present.

Keywords: Magnetic resonance imaging; Microvascular obstruction; Myocardial infarction; Ventricular arrhythmias.

Publication types

Controlled Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Algorithms
Diagnosis, Computer-Assisted / methods*
Electrocardiography / methods*
Female
Humans
Male
Middle Aged
Myocardial Reperfusion
Prognosis
Recovery of Function
Reproducibility of Results
Risk Factors
ST Elevation Myocardial Infarction / complications*
ST Elevation Myocardial Infarction / diagnosis
ST Elevation Myocardial Infarction / surgery*
Sensitivity and Specificity
Treatment Outcome
Ventricular Premature Complexes / diagnosis*
Ventricular Premature Complexes / etiology*
Ventricular Premature Complexes / prevention & control