Background: Primary ventricular fibrillation (PVF) is defined as VF occurring within 48 hours after ST-elevation myocardial infarction (STEMI) in patients with no heart failure or cardiogenic shock. PVF is associated with increased in-hospital mortality. However, data on its long-term prognostic implications in the era of complete revascularization remain controversial. We therefore evaluated the long-term prognosis of PVF in STEMI patients undergoing percutaneous coronary intervention (PCI).
Methods: Among 1367 consecutive patients hospitalized with STEMI during the 5-year period of 2008-2013, 69 (5%) had PVF or sustained ventricular tachycardia (VT). This VT/VF-Group was compared with a Control Group consisting of 138 patients with STEMI but no VT/VF, admitted during the same period represent and matched by 5 parameters: gender, age, diabetes, left ventricular ejection fraction and anterior STEMI.
Results: The 30-day mortality was higher for STEMI patients with VT/VF (11.6% vs. 0.7%, p=0.001). However, long term mortality (median follow up of 3.5 years) was similar for STEMI patients with and without VT/VF, (18.8% vs. 11.7%, p=0.22). There was no difference in re-occurrence of ventricular arrhythmias between the two groups (1.4% vs. 1.5%, p=0.22). Readmission with re-infarction was actually higher in the control group (8.8% and 2.9%, p=0.11).
Conclusion: Malignant ventricular arrhythmias occurring within 48 hours of a STEMI treated with PCI are associated with increased 30-day mortality rate. However primary VT/VF does not affect long-term outcome in patients discharged alive.
