Prognostic Impact of Acute Myocardial Infarction-Related Ventricular Tachyarrhythmia in the Current Era

To the Editor:

Hanada et al conducted a comprehensive investigation that elucidated several clinical parameters linked to the occurrence of ventricular tachycardia/fibrillation (VT/VF) after acute myocardial infarction (AMI).¹ Their study showed no significant correlation between VT/VF and mid-term clinical outcomes.

Current guidelines advocate implantable cardioverter-defibrillator (ICD) treatment predicated on left ventricular ejection fraction values. Over the 20-year study duration, the indications for ICD may have evolved with the changing clinical landscape, thereby potentially influencing the prognostic implications of VT/VF.

Over the past 2 decades, pharmacological management of heart failure has undergone a profound transformation. An array of anti-heart failure agents has been introduced, facilitating reverse remodeling and serving as prophylactic measures against arrhythmogenesis. The prevalence of these therapeutic modalities may also affect the prognostic landscape of VT/VF.

In their investigation, extracorporeal membrane oxygenation or intra-aortic balloon pumping was used as mechanical circulatory support.¹ In the contemporary medical milieu, the preferred choice for cardiogenic shock resulting from AMI is a percutaneous left ventricular assist device, such as Impella, which offers robust cardiac unloading, thereby minimizing cardiac injury.² Catheter ablation for VT/VF electrical storm has demonstrated success when performed concomitantly with Impella support.³ Consequently, if we exclusively consider recent clinical data, the prognostic implications of VT/VF may be less ominous.

Disclosure

None.

• Naoya Kataoka, MD, PhD
• Teruhiko Imamura, MD, PhD
• Second Department of Internal Medicine, University of Toyama, Toyama, Japan

References

• 1.   Hanada K, Kinjo T, Yokoyama H, Tsushima M, Senoo M, Ichikawa H, et al. Incidence, predictors, and outcome associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Circ J 2023, doi:10.1253/circj.CJ-23-0023.
• 2.   Sunagawa G, Saku K, Arimura T, Nishikawa T, Mannoji H, Kamada K, et al. Mechano-chronotropic unloading during the acute phase of myocardial infarction markedly reduces infarct size via the suppression of myocardial oxygen consumption. J Cardiovasc Transl Res 2019; 12: 124–134.
• 3.   Kataoka N, Imamura T, Uchida K, Koi T, Nakamura M, Kinugawa K. Urgent catheter ablation in Japanese patients with mechanical circulatory supports suffering from refractory ventricular electrical storm. J Cardiol 2023; 81: 229–235.