Nonsustained Ventricular Tachycardia in the Setting of Acute Myocardial Infarction: Tachycardia Characteristics and Their Prognostic Implications
Abstract
Background —Nonsustained ventricular tachycardia (NSVT) has significant prognostic implications in the setting of healing and healed myocardial infarction (MI), but only limited information is available on its importance in the setting of acute MI. We evaluated the prognostic significance of NSVT characteristics in the setting of acute MI. Methods and Results —A prospective database was used to identify 112 patients with NSVT within 72 hours of acute MI. A control group was identified matched for age, sex, type of MI, and thrombolytic treatment. Mean age was 64 to 65 years in the 2 groups with 71% to 72% men. Q-wave MI was noted in 52% to 53%, and thrombolytic therapy was administered to 31% to 32% of patients in each group. In-hospital ventricular fibrillation occurred more frequently in the NSVT group (9% versus 0% in the control group; P <0.001), but total in-hospital (10% versus 4%) and follow-up mortality (10% versus 17%) did not differ between the 2 groups. With a Cox regression model, specific NSVT characteristics were predictive of mortality. The strongest predictor was time from presentation to occurrence of NSVT. Shortest RR interval during NSVT was also a univariate predictor of mortality. Multivariate analysis identified time from presentation to occurrence of NSVT as the strongest predictor of mortality ( P <0.0001). The increased relative risk of NSVT was first significant when it occurred 13 hours from presentation and continued to increase as the time from presentation to occurrence of NSVT increased, plateauing at ≈24 hours with a relative risk of 7.5. Conclusions —Contrary to prevailing clinical opinion, NSVT that occurs in the setting of acute MI does have important prognostic significance. Specifically, the currently accepted notion that NSVT that occurs within 48 hours of acute MI has no prognostic significance needs to be adjusted. Although NSVT that occurs within the first several hours of presentation does not have an associated adverse prognosis, NSVT that occurs beyond the first several hours after presentation is associated with significant increases in relative risk.
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In the late (>24 hr) post-acute MI inpatient period, detection of NSVT episodes has been associated with a higher rate of sustained VT and subsequent increased mortality.
“In the late (.24 hr) postacute MI inpatient period, the detection of NSVT episodes has been associated with a higher rate of sustained VT and with subsequent increased mortality”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Cheema, Sheu, Parker, Kadish, & Goldberger, 1998
The Predictors of Mortality section (p. 4) reports significantly poorer survival when NSVT occurred more than 24 hours after presentation. The paper does not report a higher rate of sustained VT in those patients; its Methods and Results (p. 1) instead report more in-hospital ventricular fibrillation in the NSVT group overall. (LLM, conf=0.88)
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- Authors
- Cheema, A. N., Sheu, K., Parker, M., Kadish, A. H., & Goldberger, J. J.
- Affiliations
- Northwestern University (US)
- Venue
- Circulation
- Published
- 1998-11-10
- Volume
- 98
- Issue
- 19
- Pages
- 2030-2036
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2125448511
- Cited by
- 87
- References
- 24
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 5 · 2017: 4 · 2016: 3 · 2015: 2 · 2013: 2 · 2012: 4
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- non-sustained ventricular tachycardia, acute myocardial infarction, prognostic value, in-hospital mortality, ventricular fibrillation, RR interval, thrombolysis, Q-wave myocardial infarction
- MeSH terms
- Aged, Female, Humans, Male, Middle Aged, Myocardial Infarction, Prognosis, Risk Factors, Multivariate Analysis, Survival Analysis, Tachycardia, Ventricular
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