Are Ventricular Arrhythmias in Patients with Coronary Atery Disease always Connected with Transient Myocardial Ischemia?

The purpose: to estimate antiarrhythytmic effect (AAE) of myocardial revascularization in patients with coronary artery disease (CAD) and ventricular arrhythmia (VA) depending on its different genesis.

Materials and Methods: 80 patients (49,5 ± 11,5 years, 64% men) with stable CAD, normal ejection fraction (52 ± 5% by Simpson) and VA. All patients have passed the coronary angiography (CA), had significant stenoses, and myocardial revascularization (MR) was performed. All patients performed Holter monitoring (HM), treadmill tests (TT), echocardiogram, noninvasive electrophysiological mapping of VA, and psychodiagnostic.

Results. The patients were divided into the 3 groups. In the I - 46,3% patients with transitory myocardial ischemia (TMI) during which appeared/progressed VA. The II– 41,3% with TMI and VA, which weren`t connected on time with TMI and were registered only at HM. The III- 12,5% patients with post-infarction cardiosclerosis had no TIM during TT, VA were registered only at rest. The results in 6 months after MR: in I-st group AAE was observed at 68%, in II-nd group – at 64%. All patients in the III group had no AAE. It is established that the ectopic pacemaker center in this group didn`t coincide neither with a scar, nor with the area of artery revascularization. The psychodiagnostics revealed the high level of trait anxiety, and 100% of AAE of the psychotherapy in these patients.

Conclusions: Genesis of VA in patients with stable CAD may be different – it can be connected or not connected with TIM. In patients with TIM AAE after MR makes more than 60% regardless of a direct or indirect connection of VA with TIM. If there is no AAE after MR it is necessary to continue to search o an immediate cause of VA. It is established that the high level of trait anxiety in these patients may be the reason of VA.