Ventricular Stimulation After Myocardial Infarction

REVIEW, August 2011, VOL I ISSUE IV, ISSN 2042-4884
10.5083/ejcm.20424884.51 , Cite or Link Using DOI
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Béatrice Brembilla-Perrot

Ventricular stimulation after myocardial infarction (MI) is still recommended (class IB) in patients with syncope and left ventricular ejection fraction (LVEF) more than 30-35%, in asymptomatic patients with a LVEF between 30-40% and with non sustained ventricular tachycardia (VT) patients at Holter monitoring. It can also identify patients at high risk of arrhythmic events in the early post-MI period. Combined with imaging methods PVS could be widely used again during VT ablation.

From 1982 to 1995, programmed ventricular stimulation (PVS) was a major technique of screening patients at risk for ventricular tachycardia (VT) and VT–related sudden death. During this time PVS was not considered advantageous for risk stratification in coronary heart disease since implantable cardioverter defibrillators (ICD): a number of landmark trials have shown a benefit of prophylactic ICD implantation in patients with only low left ventricular ejection fraction (LVEF). Now, the guidelines recommend the systematic implantation of ICD in patients with history of myocardial infarction (MI) (more than 6 weeks) and LVEF lower than 30%. However, proarrhythmic effect of ICD and other complications were reported. More, inducible VT remains an important and independent factor of cardiac mortality.

Yet, often PVS is still used after the implantation of ICD mainly for VT ablation. PVS remains a reliable method of screening the risk of sudden death in ischemic heart disease with LVEF more than 30%.