Programmed ventricular stimulation (PVS) is used to stratify the arrhythmic risk after myocardial infarction (MI). Monomorphic ventricular tachycardia<270b/min (VT) is associated with high risk, but induction of ventricular flutter or fibrillation (VF) has a discussed significance. Treatments have changed since the beginning of PVS. The purpose of the study was to look for the results of systematic PVS after MI between 1982 and 2008.
PVS was performed in 780 patients without syncope or ventricular arrhythmias, between 1982 and 2008, from 4 to 8 weeks after acute MI: 301 (group I) were studied between 1982-1989; 315 (group II) between 1990-1999 and 164 (group III) between 2000-2008. PVS used the same protocol (up to 3 extrastimuli in 2 sites of right ventricle).
Clinical and electrophysiological data were similar in groups I and II but differed in group III: age was higher in group III (61±11 years) than in group I (56±11) and II (58±11) (p<0.002); left ventricular ejection fraction (LVEF) was lower in group III (36±11%) than in group I (44±15), II (41±12) (p<0.05). PVS was as frequently negative in group III (58.5%) than in group I (52%), II (47%). VT was induced as frequently in group III (26%) than in group I (20%), II (21.5%). VF were less frequently induced in group III (15%) than in group I (28.5%) (p<0001) and II (29.5%) (p<0.01). The changes were not related to beta blockers, similar in 3 groups (65 % in group I, 68 % in group II, 72% in group III) or ACE inhibitors introduced in groups II (55%), III (65%). The changes could be related to primary angioplasty, systematic since 2000.
Induction of ventricular flutter or fibrillation is actually rarer than in years 1985/2000. The decrease corresponded with the development of primary angioplasty and revascularization. The induction of monomorphic VT<270 b/min has not changed although a lower LVEF in patients studied since 2000.Le texte complet de cet article est disponible en PDF.