C23 ELECTROCARDIOGRAPHIC PREDICTORS OF PRIMARY VENTRICULAR FIBRILLATION DURING A FIRST ACUTE MYOCARDIAL INFARCTION

Abstract Introduction Few small studies evaluated electrocardiographic (ECG) predictors of ventricular fibrillation (VF) before reperfusion during a first acute myocardial infarction (AMI). None accounted for the time between symptom onset and ECG. Objectives To evaluate ECG primary VF in PREDESTINATION (PRimary vEntricular suDden dEath firST myocardIal iNfArcTION) population. Patients methods: is an ongoing, prospective, multicenter, case–control study (1:2 match sex age) enrolling patients aged 18–80 with AMI, whether complicated (cases) or not (controls) by reperfusion. For present analysis, we matched 1:1 age, sex, infarct site, symptom–ECG time, ECGs cases those controls revascularized at least 60 minutes after onset. traces were digitized pdf enlarged 400%. Three blind analyzes performed: on entire population, only anterior non–anterior AMI. Results currently includes 1478 (mean 59 years, 83% male), 533 whom are cases. Among cases, (58 ± 11 10% females, 64% mean symptoms–ECG 78±60 minutes, ECG–VF 23±15 minutes) had pre–VF adequate quality. Both general population (118 ECGs) AMIs subgroup (76 ECGs), presence (VEB) supraventricular ectopic beats (SVEB) was associated increased risk developing (maximum OR 8.35 VEBs AMIs). In AMIs, Tpeak–Tend interval non–infarction leads, both corrected RR (Bazett) QT (TpTe/QT) significantly longer compared to controls. A TpTe/QT ≥0.33 leads 4.6 (p=0.02) VF. Conclusions aimed identifying VF, perform rigorous matching including time. addition beats, well–known marker promoter electrical instability, identified, single additional predictor (TpTe/QT), which correlates dispersion repolarization consequently refractoriness.