Progression and predictors of long-term arrhythmic events in patients with acute myocardial infarction complicated by early ventricular tachyarrhythmias

The aim of this retrospective study was to evaluate the dynamics of left ventricular (LV) ejection fraction (EF) and end-diastolic volume (EDV) within one year after acute myocardial infarction (AMI) in patients with early and long-term sustained ventricular arrhythmias (VA); to identify the predictors of these arrhythmias; and to elucidate the relationships between VA, severity of coronary artery (CA) lesions, and parameters of LV systolic function. The study included 36 patients (33 men) aged 57.7±9.8 years with AMI complicated by early episodes of primary ventricular fibrillation (VF) or monomorphic ventricular tachycardia (VT). Patients were divided into two groups depending on whether they developed long-term VA within one year after AMI. In the VA group, there was a trend to an increase in EF and EDV. In the study group, changes in EF were not present, but EDV decreased by 30 mL relative to the baseline value. Correlation analysis did not show any associations of the number and the time of long-term VA occurrence with LV EF and EDV. The degree of correlation between VA dynamics and CA lesion severity was very high. The number of diseased CAs strongly correlated with the number of VA episodes (r=0.93; p=0.003) as well as with the time of the first arrhythmic episode onset (r=-0.83; p=0.039). Revascularization completeness correlated with the number of episodes (r=-0.83, p=0.009). Predictors of long-term VA after AMI, complicated by early arrhythmic episodes, comprised LV aneurysm, NSTEMI, type 2 diabetes, EDV, and EFЈ35%. Left ventricular aneurysm was an independent predictor of both long-term VA and early VT.