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Clinical features and treatment of ventricular arrhythmias during acute myocardial infarction

Philip J Podrid, MD, FACC
Leonard I Ganz, MD, FHRS, FACC
Section Editor
James Hoekstra, MD
Deputy Editor
Brian C Downey, MD, FACC


Death from a ventricular tachyarrhythmia in the setting of an acute myocardial infarction (MI) has historically been one of the most frequent causes of sudden cardiac death (SCD) [1,2]. In a 1985 report, for example, 60 percent of deaths associated with acute MI occurred within the first hour and were attributable to a ventricular arrhythmia, in particular ventricular fibrillation (VF) [3]. However, subsequent improvements in arrhythmia detection and treatment have had a major impact on the outcome of ventricular arrhythmias associated with acute MI. As a result, both arrhythmic and overall in-hospital mortality from acute myocardial infarction (MI) have fallen significantly [4-6]. (See "Prognosis after myocardial infarction".)

The incidence, clinical features, and treatment of ventricular tachyarrhythmias associated with acute MI will be reviewed here. Risk stratification for life-threatening ventricular arrhythmias after MI, prophylactic treatment of ventricular arrhythmias following MI, and the management of ventricular arrhythmias in the setting of chronic coronary heart disease are discussed separately. (See "Incidence of and risk stratification for sudden cardiac death after acute myocardial infarction" and "Prophylaxis against ventricular arrhythmias during and after acute myocardial infarction" and "Role of antiarrhythmic drugs for ventricular arrhythmias in patients with a prior myocardial infarction" and "Sustained monomorphic ventricular tachycardia in patients with a prior myocardial infarction: Treatment and prognosis" and "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy".)


Pre-fibrinolytic/PCI era versus PCI era — While many studies have evaluated the incidence of ventricular arrhythmias in the peri-infarct period, comparison of these studies is difficult due to differences in populations (percutaneous intervention therapy versus fibrinolytic therapy versus no therapy), type of infarct (ST segment elevation MI versus non-ST segment elevation MI versus both) and arrhythmia reported (ventricular tachycardia versus VF versus both).

Ventricular arrhythmias, ranging from isolated ventricular premature beats to ventricular fibrillation, are common in the immediate postinfarction period. Observations in the pre-fibrinolytic era found the following range of incidence [7,8]:

Ventricular premature beats (VPBs) – 10 to 93 percent

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Literature review current through: Nov 2017. | This topic last updated: Nov 15, 2016.
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