Key result
Post-STEMI EP studies map 88% of early inducible VT to the infarct scar or border.
Why the study?
Whether early post-STEMI inducible ventricular tachycardia on electrophysiology studies originates from the infarct site remains unknown.
Does the exit site of inducible ventricular tachycardia early post-STEMI correlate with the region of infarct?
Cohort (n=46)
Does the exit site of inducible ventricular tachycardia early post-STEMI correlate with the region of infarct?
The majority of early inducible post-infarct VT arises from acute myocardial scar, though a small portion arises from remote sites, with no deaths observed in patients with remote VT.
Most post-STEMI inducible VT arises from scar; leaves open whether remote sites warrant distinct management in prospective studies.
BACKGROUND: Ventricular arrhythmia (VA) is the most common cause of sudden cardiac death post-ST elevation myocardial infarction (STEMI). Ventricular tachycardia (VT) may be inducible in electrophysiology studies (EPS) early (<40 days) post-STEMI. Whether it originates from the infarct site remains unknown. We examined the correlation between inducible VT and infarct location post-STEMI. AIMS: To investigate the correlation between inducible VT and infarct location post-STEMI. METHODS: We retrospectively analysed 46 patients from 2005 to 2017 with STEMI who underwent early programmed ventricular stimulation through EPS (>48 h post-STEMI and <40 days from admission). Gated heart pool scans were used to visualise infarct scar regions, and VT exit sites were derived from induction 12-lead electrocardiography. Patients were followed up for primary outcomes of recurrent VA and all-cause mortality. RESULTS: Forty-six patients were included for analysis, with 50 uniquely induced VT exit sites. Mean left ventricular ejection fraction was 30 ± 8.7% and 22% had impaired right ventricular ejection fraction. Mean time from presentation to EPS was 16 ± 31.3 days. Of the induced VT, 44 (88%) were from within scar and scar-border regions, whereas 6 (12%) of the induced VT were found to be remote to imaging-derived scar. Over a median follow-up period of 75 months, 6 (13%) patients died, and 7 (15%) patients had recurrent VA. No deaths occurred in patients with remote VT. CONCLUSION: The majority of early inducible post-infarct VT arises from acute myocardial scar; however, a small portion arises from sites remote from scars with a possible focal aetiology.
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Rao et al. (2022) conducted a cohort in ST elevation myocardial infarction (STEMI) (n=46). Electrophysiology study (EPS) with programmed ventricular stimulation was evaluated on Recurrent ventricular arrhythmia and all-cause mortality. Electrophysiology studies post-STEMI revealed that 88% of early inducible ventricular tachycardia exit sites originated from within or bordering the infarct scar, while 12% were remote.
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