SUMMARY To determine why only some patients with a previous myocardial infarction develop serious or life-threatening ventricular arrhythmias, we performed electrophysiologic ventricular mapping during sinus rhythm in 38 patients (31 men and seven women, mean age 51 years) during open heart surgery for coronary artery disease. Twenty-nine patients had a left ventricular aneurysm or dyskinetic area, eight had an akinetic area, and one had a severe hypokinetic area. Of 21 patients who had documented ventricular arrhythmias, 16 had recurrent, sustained ventricular tachycardia, two had ventricular tachycardia during exercise testing, and three had frequent premature ventricular complexes only. Seventeen patients were free of ventricular arrhythmias.Epicardial mapping was performed in all 38 patients. The endocardium was also mapped in 10 patients. In 20 patients with ventricular arrhythmias, an area of delayed activation (more than 100 msec after onset of the QRS complex) was found. This type of delay was present in only two of the 17 patients without arrhythmias. The mean latest epicardial activation in patients with arrhythmias was 137 + 21 msec, whereas in patients without arrhythmias, the mean latest epicardial activation was 74 + 21 msec (p < 0.001). Twenty of the 21 patients with arrhythmias had fractionated electrograms (three exclusively on the endocardium) and 13 patients had double potentials. Fractionation and double potentials were found in only one of the 17 patients without arrhythmias. The area where abnormal electrograms were recorded (i.e., the number of abnormal recording sites) was significantly larger in patients with recurrent sustained ventricular tachycardia than in patients who had premature ventricular complexes only or had no documented arrhythmias. We conclude that in patients with a previous myocardial infarction associated with serious or life-threatening ventricular arrhythmias, areas of significantly delayed epicardial activation, fractionation and double potentials are characteristic findings of ventricular mapping during sinus rhythm, and presumably constitute the substrate for development of these arrhythmias.A CORRELATION between the incidence of ventricular arrhythmias in man and the extent of abnormally contracting myocardium caused by myocardial infarction has been observed by several investigators.

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With a few exceptions, prevailing data on return to work after coronary artery bypass surgery indicate no net gain in employment status for at least several years after the operation. Despite the improved surgical experience and advances in the medical management of postoperative patients, only limited employment benefits occur after surgery, and no gains in work rehabilitation over the past decade have been noted. Several characteristics--preoperative work status, nonwork income, occupation, relief of symptoms, age, perception of health, education and severity of disease--appear to be important for estimating the likelihood of employment after surgery. Other influences, such as attitudes of the family, employers and physicians, undoubtedly alter the probability of return to the work force, but are less well documented. Unless constructive approaches toward work rehabilitation are made, the possibility of return to gainful employment should not be considered an indication for or a necessary consequence of coronary artery bypass surgery.