AbstractThe objective of the research was to study the ECG phenomena in patients with post-infarction left ventricular aneurysm (PLVA) depending on the treatment approach.Materials and methods. We analyzed results of 24-hour ECG monitoring of 238 patients with PLVA. The main group was divided into 3 subgroups depending on the treatment approach: patients who were treated with optimal background therapy (OBT), percutaneous coronary interventions (PCI), coronary artery bypass graft (CABG) surgery. All patients underwent 24-hours standard ECG monitoring.Results. Our research showed that 50.0% of patients of the first group had tachycardia. AV-junction conduction problems often were observed in those persons (PQ interval was 179.7±8.4 ms, which was significantly higher than in the control group, 149.3±5.4 ms, р<0.05). The longest QT interval was also stated for the first group, 532.4±27.3 ms, which was significantly longer than the average values of the control group (438.7±24.6 ms) and the second group (460.2±20.5 ms) respectively, р<0.05. Revascularization procedures (in the second and third groups) allowed achieving heart rate (HR) control in 66.1% and 62.5% of patients respectively. Complete right bundle branch block (CRBBB) was the most frequent phenomenon of patients of the third group (47.9%), which was significantly higher than in the patients of the first and control groups. We also detected a high frequency of supraventricular ectopic complexes in patients of the first and the third groups. A percentage of ventricular ectopic beats was the highest in the third group (17.7%).Conclusions. Patients with PLVA tended to have tachycardia, but the use of LV revascularization procedures allowed improvement of heart rate control. The patients were also characterized by a high percentage of impulse conduction in the atria, “AV-junction” and His bundle branches and the use of LV revascularization procedures did not improve the mentioned phenomena, and increased the risk of ectopic complexes in some cases (after CABG).Patients with PLVA had significantly prolonged “QT-interval” and therefore (along with the frequent disorders of repolarization) increased risk of sudden death. However, the use of LV revascularization (PCI) reduced it significantly.
Bosimini E, Giannuzzi P, Temporelli PL, Gentile F, Lucci D, Maggioni AP, et al. Electrocardiographic evolutionary changes and left ventricular remodeling after acute myocardial infarction11The Investigators and Institutions participating in the GISSI-3 Echo Substudy are listed in the Appendix. J Am Coll Cardiol. 2000;35:127–135. DOI: http://doi.org/10.1016/S0735-1097(99)00487-8
Goldberger AL. Myocardial Infarction: Electrocardiographic Differential Diagnosis. 4th. St. Louis: Mosby-Year Book; 1991. 386 p
Maron MS, Finley JJ, Bos JM, Hauser TH, Manning WJ, Haas TS, et al. Prevalence, clinical significance, and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation. 2008;118:1541–1549. DOI: http://doi.org/10.1161/CIRCULATIONAHA.108.781401 [PMid: 18809796]
Miller JM. Diagnosis of cardiac arrhythmias. In: Miller JM, Zipes DP, editors. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, PA: Saunders Elsevier; 2011
Myerburg RJ, Castellanos A. Cardiac arrest and sudden cardiac death. In: Braunwald E, editor. Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia: W. B. Saunders; 2001. p. 890-931
Pinto DS, Josephson ME. Sudden cardiac death. In: Fuster V, editor. Hurst's The Heart. New York: McGraw-Hill; 2001. p. 1015-1048
Voon W-C, Chen Y-W, Hsu C-C, Lai W-T, Sheu S-H. Q-wave regression after acute myocardial infarction assessed by Tl-201 myocardial perfusion SPECT. J Nucl Cardiol. 2004;11:165–70 DOI: http://doi.org/10.1016/j.nuclcard.2003.10.009 [PMid: 15052248]
Dolzhenko MN, Rudenko SA, Potashev SV. Anevrizma levoho zheludochka: neuzheli vse tak beznadezhno? [Left ventricle aneurysm: is everything so hopeless?]. Mistetstvo likuvannia. 2006;7:9–13
Goigo OV. Practical application of statistical packege STATISTIKA" for analysis of medical and biological data. Kiev: 2004. 76 p
Orlov VN. Electrocardiography for the Practicing Physician. Moscow: Mir; 1988
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