Huikuri H V, Koistinen M J, Airaksinen K E, Ikäheimo M J
Department of Medicine, University of Oulu, Finland.
Heart. 1996 Jan;75(1):17-22. doi: 10.1136/hrt.75.1.17.
To study the significance of perfusion of the infarct related coronary artery for susceptibility to ventricular tachyarrhythmias in patients with a remote myocardial infarction.
Tertiary referral cardiac centre.
Angiographic filling of the infarct related artery was assessed in a consecutive series of 85 patients with different susceptibilities to ventricular tachyarrhythmias after previous (> 3 months) Q wave myocardial infarction: 30 patients had a history of cardiac arrest (n = 16) or sustained ventricular tachycardia (n = 14), and sustained ventricular tachyarrhythmia was inducible in these by programmed electrical stimulation (arrhythmia group); 47 patients had no clinical arrhythmic events and no inducible ventricular tachyarrhythmias during programmed ventricular stimulation (control group). Eight patients without a history of any arrhythmic events were inducible into ventricular tachycardia.
The patients in the arrhythmia group were older (63 (SD 8) years) than the control patients (59 (6) years, P < 0.05), and had larger left ventricular volumes in cineangiography (P < 0.01), but ejection fraction, severity of left ventricular wall motion abnormalities, previous thrombolytic therapy, and time from previous infarction did not differ between the groups. Patients with susceptibility to ventricular tachyarrhythmias more often had a totally occluded infarct related artery on angiography (77%) than patients without arrhythmia susceptibility (21%) (P < 0.001), and complete collateral filling of the infarct artery in cases without complete anterograde filling was less common in the arrhythmia group than in the control group (P < 0.001). Patients without a history of malignant arrhythmia but with inducible ventricular tachyarrhythmia also had no or poor perfusion of the infarct artery more often than the patients without inducible arrhythmia (P < 0.001). Logistic multiple regression showed that no or poor anterograde or collateral filling of the infarct related artery was the most powerful predictor of susceptibility to ventricular tachyarrhythmias (P < 0.001). Left ventricular size and function were not independently related to arrhythmic susceptibility.
No or poor angiographic filling of the infarct related artery is closely associated with susceptibility to ventricular tachyarrhythmias late after acute myocardial infarction, suggesting that perfusion of the infarct artery will modify favourably the electrophysiological substrate of the infarct scar independently of the myocardial salvage achieved by early reperfusion.
研究梗死相关冠状动脉灌注对陈旧性心肌梗死患者室性快速心律失常易感性的意义。
三级转诊心脏中心。
对85例既往（>3个月）Q波心肌梗死后对室性快速心律失常易感性不同的患者进行连续观察，评估梗死相关动脉的血管造影充盈情况：30例患者有心脏骤停史（n = 16）或持续性室性心动过速史（n = 14），且通过程控电刺激可诱发持续性室性快速心律失常（心律失常组）；47例患者在程控心室刺激期间无临床心律失常事件且未诱发室性快速心律失常（对照组）。8例无任何心律失常事件史的患者可诱发室性心动过速。
心律失常组患者年龄（63（标准差8）岁）大于对照组患者（59（6）岁，P<0.05），心血管造影显示左心室容积更大（P<0.01），但两组间射血分数、左心室壁运动异常严重程度、既往溶栓治疗情况及距上次梗死时间无差异。对室性快速心律失常易感的患者在血管造影上梗死相关动脉完全闭塞的情况（77%）比不易感心律失常的患者（21%）更常见（P<0.001），在无完全顺行充盈的情况下梗死动脉完全由侧支循环充盈在心律失常组比对照组更少见（P<0.001）。无恶性心律失常病史但可诱发室性快速心律失常的患者梗死动脉无灌注或灌注不良的情况也比未诱发心律失常的患者更常见（P<0.001）。多因素logistic回归显示梗死相关动脉无顺行或侧支循环充盈或充盈不良是室性快速心律失常易感性的最强预测因素（P<0.001）。左心室大小和功能与心律失常易感性无独立相关性。
梗死相关动脉血管造影无充盈或充盈不良与急性心肌梗死后晚期室性快速心律失常易感性密切相关，提示梗死动脉灌注可独立于早期再灌注实现的心肌挽救而有利地改变梗死瘢痕的电生理基质。
