Malignant Ventricular Arrhythmias in Patients With Acute Right Ventricular Infarction Undergoing Mechanical Reperfusion

Ricci, Jason; Dukkipati, Srinivas R.; Pica, Mark; Haines, David E.; Goldstein, James A.

doi:10.1016/j.amjcard.2009.07.047

Cited by 21 publications

(5 citation statements)

References 17 publications

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“…AV nodal block occurring beyond the first 24 h of infarction tends to be atropine insensitive; it has been suggested to be secondary to adenosine release by the ischaemic myocardium39 40 and may therefore respond to aminophylline 41. Ventricular tachyarrhythmias from the dilated RV are common in the acute setting, complicating up to a third of cases10 11 42 43 particularly in the absence of coronary reperfusion,28 though late scar-related arrhythmias are unlikely 20…”

Section: Occurrence Of Rvmimentioning

confidence: 99%

Right ventricular myocardial infarction: pathophysiology, diagnosis, and management

Kakouros

Cokkinos

2010

Postgraduate Medical Journal

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Right ventricular (RV) ischaemia complicates up to 50% of inferior myocardial infarctions (MIs), though isolated RV myocardial infarction (RVMI) is extremely rare. Although the RV shows good long term recovery, in the short term RV involvement portends a worse prognosis to uncomplicated inferior MI, with haemodynamic and electrophysiologic complications increasing in-hospital morbidity and mortality. Acute RV shock has an equally high mortality to left ventricular (LV) shock. Identification of RV involvement, particularly in the setting of hypotension, can help anticipate and prevent complications and has important management implications which are distinct from the management of patients presenting with LV infarction. Reperfusion therapy, particularly by primary percutaneous coronary intervention, hastens and enhances RV functional recovery that occurs to near normality in most patients. The diagnostic methods for RVMI are discussed, including clinical, electrocardiographic, and various imaging modalities as well as the RV pathophysiology that underpins the specifics of RVMI management.

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Section: Occurrence Of Rvmimentioning

confidence: 99%

Right ventricular myocardial infarction: pathophysiology, diagnosis, and management

Kakouros

Cokkinos

2010

Postgraduate Medical Journal

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“…Ventricular tachycardia/ventricular fibrillation may develop either during acute occlusion, abruptly with reperfusion, or in a later phase. In our study, primary PCI dramatically reduces the incidence of malignant ventricular arrhythmias and heart blocks, presumably through improvement in right ventricular function, which lessens late ventricular arrhythmias and heart block (4,26). Moreover, increased risks for bradyarrhythmia and ventricular tachyarrhythmias contribute to increased risk of in-hospital morbidity and mortality (21,27).…”

Section: Discussionmentioning

confidence: 63%

Short- and Long-Term Outcomes in Patients With Right Ventricular Infarction According to Modalities of Reperfusion Strategies in China: Data From China Acute Myocardial Infarction Registry

Chen

Yang

et al. 2022

Front. Cardiovasc. Med.

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PurposeWe sought to investigate the short- and long-term outcomes in patients with right ventricular infarction in China.MethodsData from China Acute Myocardial Infarction (CAMI) Registry for patients with right ventricular infarction between January 2013 and September 2014 were analyzed.ResultsOf the 1,988 patients with right ventricular infarction, 733 patients did not receive reperfusion therapy, 281 patients received thrombolysis therapy, and 974 patients underwent primary PCI. Primary PCI and thrombolysis were all associated with lower risks of in-hospital (3.1 vs. 12.6%; adjusted OR: 0.48; 95% CI: 0.27–0.87; P = 0.0151 and 5.7 vs. 12.6%; adjusted OR: 0.43; 95% CI: 0.22–0.85; P = 0.0155, respectively), and 2-year all-cause mortality (6.3 vs. 20.9%; adjusted HR: 0.50; 95% CI: 0.34–0.73; P = 0.0003 and 11.0 vs. 20.9%; adjusted HR: 0.59; 95% CI: 0.38–0.92; P = 0.0189, respectively), compared with no reperfusion therapy. Meanwhile, primary PCI was superior to thrombolysis in reducing the risks of in-hospital atrial-ventricular block (4.2 vs. 8.9%; adjusted OR: 0.46; 95% CI: 0.23–0.91; P = 0.0257), cardiogenic shock (5.3 vs. 13.9%; adjusted OR: 0.43; 95% CI: 0.23–0.83; P = 0.0115), and heart failure (8.5 vs. 23.5%; adjusted OR: 0.35; 95% CI: 0.22–0.56; P < 0.0001). Primary PCI could reduce the risk of 2-year major adverse cardiac and cerebrovascular event (19.1 vs. 33.3%; adjusted HR: 0.72; 95% CI: 0.56–0.92; P = 0.0092) relative to no reperfusion therapy, whereas thrombolysis may increase the risk of 2-year revascularization (15.5 vs. 8.7%; adjusted HR: 1.90; 95% CI: 1.15–3.16; P = 0.0124) compared with no reperfusion therapy.ConclusionsTimely reperfusion therapy is essential for patients with right ventricular infarction. Primary PCI may be considered as the default treatment strategy for patients with right ventricular infarction in the contemporary primary PCI era.

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“…The RV is involved in 30–50% of patients with LV inferior wall and/or infero-septal myocardial infarction 12 . In the acute phase of RV myocardial infarction, electrical instability frequently occurs as malignant ventricular tachyarrhythmias or electrical storms have been reported in 38% and 8.3% of the cases, respectively 13 . However, the RV is more resistant to relatively long periods of ischaemia, and it better recovers contractility after reperfusion 14 .…”

Section: Discussionmentioning

confidence: 99%

Right ventricular free-wall scar: an exceptional source of post-infarction ventricular tachycardia. A case report

Tritto

Renzullo

Zagari

et al. 2019

European Heart Journal - Case Reports

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Background In patients with coronary artery disease, ventricular tachycardia (VT) is usually related to left ventricular (LV) post-infarction scars. Case summary A case of a 78-year-old man with post-infarction VT originating from the right ventricular (RV) free wall is described. Following recurrent episodes of VT with left bundle branch block morphology and left superior axis deviation, a patient with prior myocardial infarction was submitted to catheter ablation. Two areas of abnormal bipolar electrograms were observed at 3D electroanatomical mapping: one located at the basal aspect of the posterior and postero-septal LV, and the other one extending from the antero-lateral to the posterior mid-basal RV free wall. Ventricular late potentials (LPs) were recorded within both scars, but only pacing from those located in the RV resulted in long stimulus-to-QRS latency and optimal pace-mapping. Accordingly, this substrate was deemed the culprit of the clinical VT. Radiofrequency catheter ablation aimed at eliminating all LPs recorded from both scars was effective in preventing VT recurrences at follow-up. Discussion A post-infarction RV free-wall scar may exceptionally be responsible of VT occurrence. Right ventricular mapping should be considered in selected cases based on 12-lead electrocardiogram VT morphology and prior RV infarct.

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Malignant Ventricular Arrhythmias in Patients With Acute Right Ventricular Infarction Undergoing Mechanical Reperfusion

Cited by 21 publications

References 17 publications

Right ventricular myocardial infarction: pathophysiology, diagnosis, and management

Right ventricular myocardial infarction: pathophysiology, diagnosis, and management

Short- and Long-Term Outcomes in Patients With Right Ventricular Infarction According to Modalities of Reperfusion Strategies in China: Data From China Acute Myocardial Infarction Registry

Right ventricular free-wall scar: an exceptional source of post-infarction ventricular tachycardia. A case report

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