Significance of inducible ventricular flutter-fibrillation after myocardial infarction

Significance of Inducible Ventricular Flutter-Fibrillation After Myocardial Infarction. Aim: The purpose of this study was to determine the factors associated with the induction of ventricular flutter/fibrillation (VFl/VF) and its prognostic significance in post-myocordiol infarction. Methods: Programmed ventricular stimulation was performed after myocardial infarction (MI) for syncope (n = 232) or systematically (n = 755); 230 patients hod on induced VFl/VF and were followed during 4 +/- 2 years. Results: VFl/VF was induced in 49/232 patients (21%) with syncope versus 181/755 osymptomatic patients (24%) (NS) and 94/410 patients (23%) with left ventricular ejection fraction (LVEF) < 40% versus 136/577 patients (22.5%) with LVEF > 40% (NS). Cardiac mortality was 9%; LVEF was 33 +/- 15% in patients who died, 43 +/- 13% in alive patients (P < 0.004). In patients with LVEF < 40%, induced VFl/VF, mortality rate was 31% in those with syncope, 10% in osymptomatic patients (P < 0.001), because of an increase of deaths by heart failure; patients with LVEF > 40% with or without syncope had a low mortality (5% and 3%). After linear logistic regression, VFl/VF and LVEF were predictors of total cardiac mortality, but only LVEF < 40% predicted sudden death. Conclusion: Syncope and the level of LVEF did not increase the incidence of VFl/VF induction after MI, but modified the cardiac mortality: induced VF increased total cardiac mortality in patients with syncope and LVEF < 40%, but did not increase sudden death. In patients with LVEF > 40%, induced VFl/VF has no significance neither in asymptomatic patients nor in those with syncope.