ventricular arrythmias following STEMI

  • related: Cardiology
  • tags: #literature #cardiology

Ventricular arrhythmias, including isolated premature ventricular complexes, couplets, and NSVT, are common within the first 48 h of a myocardial infarction (MI), which is considered the immediate postinfarction period. More serious arrhythmias, such as sustained ventricular tachycardia and ventricular fibrillation, are less common, but arrhythmias within this time period are not felt to worsen long-term prognosis, as most of them are believed to be reperfusion arrhythmias. Late ventricular tachycardia and ventricular fibrillation are more ominous and are associated with increased mortality.

As such, antiarrhythmic therapy is not indicated for asymptomatic NSVT without hemodynamic compromise within 48 h of MI, as in this case (choice A is incorrect), nor is placement of an implantable defibrillator for secondary prevention (choices B and D are incorrect).

No further therapy is indicated (besides beta blocker). Whether to place an implantable defibrillator for primary prevention after MI is a different question, but the guideline indications are ejection fraction less than 40% on optimal medical therapy after a waiting period of at least 90 days after revascularization to allow for the potential for ventricular recovery.12

Footnotes

  1. SEEK Questionnaires ↩

  2. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018;72(14):e91-e220. PubMed ↩