| Objective:To investigate the risk factors of ventricular arrhythmia (VA) in patients with healed myocardial infarction (HMI), locate the incidence regions, and study the correlation between heart rate variability (HRV), left ventricle function, early repolarization variant (ERV), fragmented QRS (fQRS) and ventricular arrhythmias in the HMI population.Methods:183patients who had a history of HMI longer than30days were studied. Patients were divided into A group (ventricular arrhythmia group, n=100) and B group (the group without ventricular arrhythmia, n=83), at the same time,60patients without coronary heart disease (C group) were studied.1. Age, gender, history of hypertension, history of diabetes, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), akinesia or dyskinesia, ventricular aneurysm, history of using β-adrenergic receptor blockers and angiotension converting enzyme inhibitors (ACEI), whether undergoing emergency percutaneous coronary intervention (PCI), number of diseased vessels, history of postinfarction unstable angina, culprit vessel, location of MI, laboratory data were recorded and compared between A group B group. The important risk factors of VA were determined by Logistic regression analysis.2. Compared the HRV, LVEF, ERV, fQRS in three groups.3. The group A were divided into two different groups according to ventricular premature contraction Lown’s scales, compared the difference of HRV, LVEF, ERV, fQRS in two groups.4. Group A was divided into anterior myocardial infarction group and inferior myocardial infarction group to compare the location of incidence regions in two groups.5. HMI was divided into two groups according to undergoing emergency PCI or elective PCI to compare LVEF, LVEDD and dyskinesia in two groups.Results:1. Logistic regression analysis showed the LVEF, LVEDD were independent risk factors of VA in patients with a healed infarction history. The highest contribution was LVEDD.2. Compared with group C, the patients in group A had a lower HRV analysis parameters:SDNN, SDANN Index, SDNN Index, rMSSD, pNN50 (P<0.05), their early repolariztion and fQRS were more frequent (P<0.05). LVEF in three groups are gradually increase (P<0.05). Compared with group B, group A had a lower SDANN Index.3. Compared with the healed MI patients with Lown’s scale1-2, the patients with Lown’s3～5scales had a lower SDNN, SDANN Index, LVEF (P<0.05).4. The predilection sites of VA in anterior myocardial infaction were antero-lateral area, infero-septum area, apical. The predilection sites of VA in inferior myocardial infaction were infero-septum area, RVOT and middle septum. Compared with the inferior myocardial infarction, anterior myocardial infaction had a higher incidence in antero-lateral area, apical and had a lower incidence in infero-septum area (P<0.05).5. There were no difference on LVEF, LVEDD and dyskinesia in patients undergoing emergency PCI or elective PCI.Conclusion:1. LVEDD and LVEF are vital independent determinant of VA in patients with a HMI history.2. In patients with ventricular arrhythmias attributed to HMI, the HRV and LVEF are significantly decreased, the incidence of ERV and fQRS are significantly increased. And the decline of HRV and LVEF are associated with the severity of ventricular ai hythmias.3. The predilection sites of VA in anterior myocardial infaction are antero-lateral area and apical. The predilection sites of VA in inferior myocardial infaction is infero-sepum area. It is estimated that these sites receive a multiple blood supply and have high density of Purkinje fibers. |
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