Clinical significance of supraventricular tachyarrhythmias after acute myocardial infarction

Abstract

160 survivors of acute myocardial infarction (AMI) were evaluated to assess the clinical significance of supraventricular tachyarrhythmias (SVTA) occurring at discharge from the hospital after the acute event. All the variables considered for the study were estimated before hospital discharge; arrhythmias were quantified with a 24 h Holter ECG monitoring system. SVTA occurred in 88 patients (55%). Single or repetitive supraventricular premature beats were found in 65 (41%), paroxysmal atrial or junctional tachycardias in 20 (12%), bouts of atrial flutter or fibrillation in 3 (2%). Bivariate statistical analysis showed no relationship between sex, previous cardiovascular history, type, and location of AMI and SVTA occurrence. A close positive relationship was found between age, left atrial dimension (LAD), cardio-thoracic ratio (CTR) and SVTA occurrence; an inverse relationship was found for left ventricular ejection fraction (LVEF). The presence of SVTA appeared significantly related to age above 55 years, to LAD greater than 40 mm, to LVEF less than 45%, to serum creatine kinase peak levels over 1400 U l-1 and to CTR over 0.49. Multivariate statistical analysis showed that five variables are important in discriminating patients suffering from SVTA: age, LAD, LVEF, left ventricular fractional shortening, and CTR. SVTA occurring at discharge from hospital after AMI are indicative of impaired left ventricular pump function.

Short- and Long-Term Prognostic Implications of In-Hospital Postinfarction Arrhythmias

“…Well in agreement with others, the prevalence of supra ventricular tachycardia in the present study was 14% [9], Supraventricular tachyarrhythmias occurring early after AMI has been associated with an increased risk of subse quent cardiac death [10]. It has been demonstrated to develop in the presence of large myocardial infarct and left-ventricular dysfunction [11], In the study by Berisso et al [9] of 209 consecutive patients discharged postin farction, supraventricular tachycardia, during 24-hour Holter monitoring 16 ± 3 days (mean ± SD) after the infarct, did not, in a multivariate analysis, predict 2-year cardial mortality independently from cardiac enlarge- ment on chest X-ray and left-ventricular dysfunction.…”

“…The prevalence of atrial fibrillation in the present study was 3%, which is in accordance with other studies, documenting atrial fibrillation in 2% [9] to 16% [15] of patients postinfarction. Several studies demonstrated postinfarction atrial fibrillation to be an important pre dictor of short- [16,17] and long-term [18] survival, whereas others using multivariate analysis found oppos ing results [15,19], In a recent carefully conducted study of 295 elderly post-AMI patients, Nielsen [20] displayed, in a multivariate analysis, atrial fibrillation to convey prognostic information in the older (i.e.…”

“…The relation of supraven tricular tachycardia to ischemia is not clarified. Although no direct association of exercise-induced left-ventricular myocardial ischemia and supraventricular tachycardia in patients after AMI has been demonstrated [9], verapamil, an antiischemic drug, has been shown to reduce the preva lence of supraventricular tachyarrhythmias in patients after AMI with, but not without, exercise-induced myo cardial ischemia [13], Ischemia of the sinus node due to coronary artery occlusion proximal to the origin of the sinus node artery has been significantly related to devel opment of supraventricular tachyarrhythmias and sinus dysrhythmias after an AMI [14], This suggests a relation ship between supraventricular tachyarrhythmias and ischemia, which might contribute to the demonstrated prognostic power of supraventricular tachycardia.…”

“…It has been demonstrated to develop in the presence of large myocardial infarct and left-ventricular dysfunction [11], In the study by Berisso et al [9] of 209 consecutive patients discharged postin farction, supraventricular tachycardia, during 24-hour Holter monitoring 16 ± 3 days (mean ± SD) after the infarct, did not, in a multivariate analysis, predict 2-year cardial mortality independently from cardiac enlarge- ment on chest X-ray and left-ventricular dysfunction. In the present study, all episodes of supraventricular tachy cardia during the first 2 weeks postinfarction were record ed.…”

Long-Term Mortality Risk in Individuals With Atrial or Ventricular Premature Complexes (Results from the Third National Health and Nutrition Examination Survey)

“…Additionally, various other potential triggers such as ischemic artery disease 15 , myocardial infarction 16 , mitral valvular stenosis 17 , smoking 18 , alcohol use 19 , caffeine use 20 , pulmonary disease 21 , and renal failure 22 have also been associated with the development of APC’s. Despite low prevalence of the majority of these risk factors in the present cohort, our study still showed a strong association of the presence of APC’s with cardiovascular and all-cause mortality.…”