Management of Ventricular Fibrillation during Acute Myocardial Infarction

Summary

Analysis of electrocardiograms tape-recorded from patients admitted to hospital with acute myocardial infarction revealed that the pattern of ventricular extrasystolic activity was not significantly different among those who subsequently developed ventricular fibrillation and those who did not. Episodes of ventricular fibrillation occurred predominantly within 4 hours from the start of infarction. Patients were 3 times less likely to survive an episode of ventricular fibrillation if they also had left ventricular failure than if this feature was absent. Management of episodes of ventricular fibrillation was compared in patients before and after the creation of a specially staffed and equipped coronary care unit. The success of electric shock as a treatment for ventricular fibrillation was similar before and after the creation of the coronary care unit. An attempt was made to determine which features in the management of ventricular fibrillation in this and in previously published series were associated with patient survival.

Die Analyse auf Band aufgenommener Elektrokardiogramme von Patienten, welche mit akutem Herzinfarkt ins Krankenhaus eingeliefert wurden, zeigte auf, daß das Muster ventrikulärer extrasystolischer Aktivität bei denjenigen, die später ventrikuläre Fibrillation entwickelten, und denjenigen, bei denen das nicht der Fall war, sich nicht wesentlich unterschied. Episoden ventrikulärer Fibrillation traten vorwiegend innerhalb von 4 Stunden nach Beginn des Infarktes auf. Die Chance von Patienten, eine Episode ventrikulärer Fibrillation zu überleben, war bei gleichzeitigem ventrikulären Versagen dreimal geringer, als wenn dies nicht der Fall war.

Die Behandlung von Episoden ventrikulärer Fibrillation wurde bei Patienten vor und nach der Schaffung einer besonders besetzten und ausgestatteten Kreislaufstation verglichen. Der Erfolg elektrischer Schocks als Behandlung für ventrikuläre Fibrillation war vor und nach der Schaffung der Kreislaufstation der gleiche. Es wurde versucht festzustellen, welche Merkmale bei der ventrikulären Fibrillation in dieser und früher veröffentlichten Reihen mit dem Überleben der Patienten in Zusammenhang standen.

Key-Words:

Acute Myocardial Infarction - Ventricular Fibrillation - Electric Shock Treatment

Schlüssel-Wörter:

Akuter Herzinfarkt - ventrikuläre Fibrillation - elektrische Schockbehandlung

• References

• 1 Bloom B. S., Peterson O. L.. End results, cost and productivity of coronary-care units. New Engi. J. Med 1973; 288: 72-78.
• 2 Bloomfield D. K., Slivka J., Vossler S., Edelstein J.. Survival in acute myocardial infarction before and after the establishment of a coronary care unit. Chest 1970; 57: 224-229.
• 3 Brown K. W. G., Macmillan R. L., Forbath N., Melgrano F., Scott J. W.. Coronary unit. An intensive care centre for acute myocardial infarction. Lancet 1963; II 349-352.
• 4 Campbell R. W. F., Murray A., Julian D. G.. Incidence, prevalence and significance of ventricular ectopic activity in acute myocardial infarction. In Sandoe E., Julian D. G., Bell J. W.. (Eds) Management of ventricular tachycardia — role of mexiletine. pp 457-463. Amsterdam: Excerpta Medica 1978
• 5 Campbell R. W. F., Murray A., Julian D. G.. Ventricular arrhythmias in the first 12 hours of acute myocardial infarction. Brit. Heart J 1981; 46: 351-357.
• 6 Day H. W.. An intensive coronary care area. Dis. Chest 1963; 44: 423-427.
• 7 Dhurandhar R. W., Macmillan R. L., Brown K. W. G.. Primary ventricular fibrillation complicating acute myocardial infarction. Amer. J. Cardiol 1971; 27: 347-351.
• 8 Eggertsen S. C, Berg A. O.. Is it good practice to treat patients with uncomplicated myocardial infarction at home? J. Amer. med. Ass 1984; 251: 349-350.
• 9 El-Sherif N., Myerburg R. J., Scherlag B. J., Befeler B., Aranda J. M., Castellanos A., Lazzara R.. Electrocardiographic antecedents of primary ventricular fibrillation. Brit. Heart J 1976; 38: 415-122.
• 10 Fagin I. D., Rajagopal R.. Mortality from myocardial infarction before and after establishment of a coronary care unit. J. Amer. Geriat. Soc 1968; 16: 908-918.
• 11 Flynn R. L., Fox S. M.. Coronary care programs in the United States. Israel J. med. Sci 1967; 3: 279-286.
• 12 Goldberg R., Szklo M., Tonascia J., Kennedy H. L.. Lengths of time between hospital admission and ventricular fibrillation or cardiac arrest complicating acute myocardial infarction: effect on prognosis. Johns Hopkins med. J 1979; 145: 187-191.
• 13 Hofvendahl S.. Influence of treatment in a coronary care unit on prognosis in acute myocardial infarction. Acta med. scand. Suppl 1971; 519: 1-78.
• 14 Lawrie D. M.. Ventricular fibrillation in acute myocardial infarction. Amer. Heart J 1969; 78: 424-426.
• 15 Levenstein J. H.. Myocardial infarction and the evolution of the intensive coronary care unit. South African med. J 1976; 50: 918-926.
• 16 Lie K. I., Wellens H. J. J., Downar E., Durrer D.. Observations on patients with primary ventricular fibrillation complicating acute myocardial infarction. Circulation 1975; 52: 755-759.
• 17 Linko E., Koskinen P. J., Ruosteenoja R., Kauranen O., Hakala T.. Intensive care of myocardial infarction. Acta med. scand 1970; 187: 117-122.
• 18 Lown B., Fakhro A. M., Hood W. B., Thorn G. W.. The coronary care unit. New perspectives and directions. J. Amer. med. Ass 1967; 199: 188-198.
• 19 Lown B., Wolf M.. Approaches to sudden death from coronary heart disease. Circulation 1971; 44: 130-142.
• 20 Marshall R. M., Blount S. G.. Acute myocardial infarction. Influence of a coronary care unit. Arch. intern. Med 1968; 122: 472-475.
• 21 Martin S. P., Donaldson M. C, London C. D., Peterson O. L., Coltori T.. Inputs into coronary care during 30 years. A cost-effectiveness study. Ann. intern. Med 1974; 81: 289-293.
• 22 Mirowski M., Israel W., Antonopoulos A. G., Mower M. M., Mendeloff A. I.. Treatment of myocardial infarction in a community hospital coronary care unit. Arch. intern. Med 1978; 138: 210-215.
• 23 Morris A. L., Nernberg V., Roos N. P., Henteleff P., Roos L.. Acute myocardial infarction: survey of urban and rural hospital mortality. Amer. Heart J 1983; 105: 44-53.
• 24 Northover B. J.. The value of temporary electrical pacing for patients with acute myocardial infarction. Meth. Inform. Med 1984; 23: 23-28.
• 25 Northover B. J.. Ventricular tachycardia during the first 72 hours after acute myocardial infarction. Cardiology 1982; 69: 149-156.
• 26 O’Doherty M., Tayler D. I., Quinn E., Vincent R., Chamberlain D. A.. Five hundred patients with myocardial infarction monitored within one hour of symptoms. Brit. med. J 1983; 256: 1405-1408.
• 27 Oliver M. F., Julian D. G., Donald K. W.. Problems in evaluating coronary care units: their responsibilities and their relation to the community. Amer. J. Cardiol 1967; 20: 465-474.
• 28 Pantridge J. F., Geddes J. S.. A mobile intensive-care unit in the management of myocardial infarction. Lancet 1967; II 271-273.
• 29 Pantridge J. F., Webb S. W., Adgey A. A. J.. Arrhythmias in the first hour of acute myocardial infarction. Progr. car-diovasc. Dis 1981; 23: 265-278.
• 30 Peterson O. L.. Myocardial infarction: Unit care or home care? Ann. intern. Med 1978; 88: 259-261.
• 31 Reynell P. C, Reynell M. C. The cost-benefit analysis of a coronary care unit. Brit. Heart J 1972; 34: 897-900.
• 32 Robinson J. S.. Coronary care unit versus hospital mortality in acute myocardial infarction. Israel J. Med. Sci 1969; 5: 772-776.
• 33 Schamroth L.. The disorders of cardiac rhythm. Oxford: Blackwell. 1971