Ventricular arrhythmias during acute myocardial ischemia/infarction: Mechanisms and management

Abstract

Ventricular arrhythmias during the acute phase of myocardial infarction are common and account for approximately 80 % of sudden cardiac death cases. A biphasic curve has been observed in various species and possibly applies also in man. The incidence of ventricular arrhythmias in the prehospital phase has remained stable during the past decade, but in-hospital rates have declined markedly, mainly due to the widespread use of reperfusion therapies. Ventricular tachycardia and fibrillation are generated by all known arrhythmogenic mechanisms, acting successively or in combination. However, the factors governing the susceptibility to ischemia-related arrhythmias remain incompletely understood. Beta-blockade is the mainstay of treatment; class I agents have been largely superseded by amiodarone, but combined administration may be warranted in difficult cases. The effect of ventricular arrhythmias on long-term prognosis needs to be examined in large-scale studies.