Stumme Myokardischämie und ventrikuläre Rhythmusstörungen

Research paper by M. Diederich, D. Bethge, K.-P. Bethge

Indexed on: 01 Apr '98Published on: 01 Apr '98Published in: Herzschrittmachertherapie & Elektrophysiologie


In patients with coronary artery disease, it is controversial whether cardiac arrhythmias result from acute subendocardial ischemia. The aim of this study was to analyze the relationship between myocardial ischemia and ventricular arrhythmia.We studied 165 outpatients with coronary artery disease (Mean age 58±7.8 years). Ventricular function was measured by echocardiography. Myocardial ischemia was evaluated from ST-segment changes during stress testing and Holter monitoring. Ventricular arrhythmias were correlated with ischemic episodes during Holter monitoring. Ventricular arrhythmias did not occur more often in patients with ischemic episodes as compared to patients without ST-segment changes.In patients with ST-segment alterations there was an increase in frequency and complexity of the ventricular arrhythmias during ischemia. There was, however, no difference between silent and symptomatic episodes. Patients with echocardiographic findings of hypertrophy or contractile dysfunction had a higher incidence of ventricular arrhythmia, but the increase of arrhythmia during ischemia was less in comparison to patients without stuctural defects.In conclusion, patients with coronary artery disease are at higher risk for ventricular arrhythmia during silent or symptomatic ischemia, but this risk is not greater than that in patients with coronary artery disease without ischemic episodes during Holter monitoring.