Circulation, Vol 52, 755-759, Copyright © 1975 by American Heart Association
KI Lie, HJ Wellens, E Downar and D Durrer
In order to evaluate the events preceding primary ventricular fibrillation
(PVF), continuous tape recording was performed in 262 patients
consecutively admitted to the hospital within six hours of infarction in
whom antiarrhythmic therapy was withheld. Warning arrhythmias (defined as
ventricular ectopic beats occurring with a frequency of more than five
beats per minute, in runs, falling in the vulnerable phase of the cardiac
cycle or being multiformed) were registered in an equal percentage in
patients who did or did not develop PVF. Immediately prior to PVF seven
patients showed sinus tachycardia, 10 a sinus rate ranging from 60 to 100
beats per minute and two bradycardia due to complete atrioventricular
block. The ventricular ectopic beat initiating PVF had a late coupling
interval (QR'/QT larger than or equal to 0.85) in 11 patients and a left
bundle branch block configuration as frequent as a right bundle branch
block. Conclusions: 1) Warning arrhythmias are not considered good criteria
for institution of antiarrhythmic therapy in order to prevent PVF. 2) In
patients with sinus rhythm there may be an association between heart rate
and onset of PVF. 3) The malignancy of a ventricular ectopic beat is not
determined by its coupling interval or its configuration.
ARTICLES
Observations on patients with primary ventricular fibrillation complicating acute myocardial infarction
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