Programmed ventricular stimulation in survivors of acute myocardial infarction: long-term follow-up

Brembilla‐Perrot, Béatrice; Chaise, A. Terrier De La; Briançon, Serge; Suty-Selton, C; Beurrier, Daniel; Martin, N.; Thiel, B; Louis, Pierre; Danchin, Nicolás

doi:10.1016/0167-5273(95)02273-y

Cited by 21 publications

(33 citation statements)

References 15 publications

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“…In a previous study in 492 survivors of myocardial infarction [4], we confirmed the higher risk of arrhythmic events in patients with inducible monomorphic ventricular tachycardia than in patients without inducible ventricular arrhythmias or with inducible ventricular fibrillation. We then wanted to determine the effects of antiarrhythmic drugs on prognosis.…”

supporting

confidence: 65%

“…Early in the use of systematic pro: grammed stimulation after myocardial infarction in 1983, treatment of patients with inducible VT was neither randomized nor controlled. These results were previously reported [4]. Beginning in 1989 a controlled study was undertaken, and 196 patients, who gave an informed consent, were randomized after programmed ventricular stimulation: 97 patients did not receive an antiarrhythmic drug (control group), but 83 of them received systematic beta-blockers after programmed ventricular stimulation.…”

Section: Study Protocolsupporting

confidence: 52%

“…Several studies have noted that the ability to induce sustained monomorphic ventricular tachycardia at programmed stimulation in survivors of myocardial infarction without spontaneous arrhythmias can de-The criteria for exclusion were reported in the first study [4]: (1) early recurrence of angina requiring therapy with a beta-adrenergic blocker, calcium channel antagonist, or coronary artery bypass grafting; (2) spontaneous VT within the first 48 hours after infarction; (3) clinical heart failure not controlled by treatment with furosemide; (4) significant noncardiac disease; and (5) chronic amiodarone treatment.…”

Section: Study Populationmentioning

confidence: 99%

“…Pacing was performed with a programmable stimulator (Explorer 2000, ELA Medical) using 1.8 msec rectangular pulses at twice the late diastolic threshold. Our pacing protocol for studying cardiac electrophysiologic properties and for initiating VT was previously described in detail [4,5]. In brief, programmed right ventricular stimulation was performed during sinus rhythm and during ventricular pacing at two cycle lengths (600 and 400 msec) using one and two extrastimuli at the right ventricular apex.…”

Section: Study Protocolmentioning

confidence: 99%

“…This study group was drawn from a group of 634 consecutive patients admitted to a university hospital (Brabois Hospital) after acute myocardial infarction for the evaluation of their status after infarction. The results of systematic ventricular stimulation in the first 492 patients were published previously [4]. Among these 634 patients, 63 had inducible ventricular fibrillation, 348 had a negative study, and 223 had inducible monomorphic VT.…”

mentioning

confidence: 99%

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Programmed ventricular stimulation after myocardial infarction does not help reduce the risk of ventricular events

Brembilla‐Perrot¹,

Jacquemin²,

A³

et al. 1996

Cardiovasc Drug Ther

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Programmed ventricular stimulation could be a useful technique to detect patients at high risk for ventricular arrhythmias and sudden death after acute myocardial infarction. However, prevention of arrhythmic events using this technique has never been demonstrated. To determine whether prophylactic antiarrhythmic therapy influences prognosis after acute myocardial infarction, 196 patients without spontaneous ventricular tachycardia (VT) but with inducible sustained monomorphic VT were followed for 3 +/- 1 years. Ninety-seven patients were not treated (control group). In 99 patients (study group), the antiarrhythmic therapy was guided by electrophysiologic study: One to four trials using class I, II, and III antiarrhythmic drugs were performed until the VT was not inducible or the induced VT was slower and was associated with hemodynamic stability. An effective antiarrhythmic drug prevented VT induction in 34 patients (34%; group I). Sixty-five patients (group II) still had inducible VT with the antiarrhythmic drug. Group II differed from group I in having a higher incidence of an inferior myocardial infarction location (57% vs. 47%; NS), a lower left ventricular ejection fraction (36.5% vs. 41%; NS), a slower rate of induced VT in the control state (227 vs. 255 beats/min; p < 0.05), and a higher number of drug trials (1.9 vs 1.3; p < 0.001). During the follow-up in the control group and in groups I and II, the incidence of total cardiac events was 25%, 15%, and 16% (NS), respectively, and the incidence of total arrhythmic events (VT, sudden death) was 18.5%, 9%, and 12% (NS). Only the risk of VT was reduced (14%, 0%, and 4%; p < 0.05). In conclusion, guided-antiarrhythmic therapy, including class III agents after acute myocardial infarction, was successful in only 34% of patients, and the incidence of arrhythmic events was not significantly decreased. Therefore, programmed ventricular stimulation does not help in managing patients at risk of ventricular arrhythmia after myocardial infarction but could help indicate the need for nonmedical treatment, such as device therapy.

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supporting

confidence: 65%

Section: Study Protocolsupporting

confidence: 52%