Ventricular extrasystoles in the convalescence phase of myocardial infarction. Relation to angiographic data

: A series of 80 patients hospitalised for recent myocardial infarction underwent: --three continuous ambulatory 24 hour recordings (Holter method) on the 15th, 22nd days, and 6 months after infarction; --selective coronary angiography with left ventriculography, with a study of left ventricular performance and analysis of segmental contractility (Leighton's method). Five patients died over a mean follow-up period of 16 months. At the third week when physical activities were reintroduced 72,3 p. 100 of patients had frequent ventricular extrasystoles (Lown's Class II) or repeated ventricular extrasystoles (Classes III, IV, V). Holter monitoring gave reproducible results with a tendency to aggravation between the Ist and the 6th month (repetitive ventricular activity increasing from 35 to 45 p. 100). 55 p. 100 of posterior infarcts had few extrasystoles whilst 47 p. 100 of anterior infarcts had severe arrhythmias (Classes III, IV and V). There was a significant correlation between the presence of multivessel disease and severe ventricular extrasystoles 60 p. 100 of patients with multiple vessel lesions had repetitive ventricular activity (p less than 0,02). Positive correlations were established between: severe ventricular arrhythmias and a reduction in ventricular ejection fraction (p less than 0,01), dyskinesia in the infarcted zone (p less than 0,01) and reduction in wall motion of the non infarcted zones. The presence of incomplete occlusion of early revascularisation by collateral circulation in the infarcted zone seemed to favour severe ventricular arrhythmias. Five patients died (arrhythmias or cardiac failure): the association of severe hypokinesia and reduced left ventricular performance with repetitive ventricular activity was demonstrated. It is concluded from the correlations obtained between ventriculography and continuous electrocardiographic monitoring that repetitive ventricular activity is associated with severe reduction in left ventricular performance. The immediate gravity and poor prognosis of the ventricular arrhythmias are the result of the extent of the myocardial damage.