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Local ventricular activation time and the conduction time during sinus rhythm at the induction of ventricular tachycardia (VT) and ventricular fibrillation (VF) were investigated using a canine model of chronic myocardial infarction. Of 26 dogs studied, 15 had inducible VT, 10 had inducible VF, and 1 had no inducible arrhythmias. Bipolar local ventricular electrograms were recorded during sinus rhythm from 136 sites in 10 dogs with VT and 164 sites in 11 dogs with VF. Mean activation time in dogs with inducible VT was significantly longer than in dogs with inducible VF. Furthermore, simultaneous local ventricular electrograms were recorded during the induction of VT (74 episodes) or VF (38 episodes) from the infarct border zone at the endocardium (B-EN), the epicardium (B-EP), and normal sites (N-EN, N-EP). During VT induction, the activation time at N-EN and N-EP was significantly longer than during VF induction (N-EN: 94 +/- 21, 70 +/- 19 ms; N-EP: 83 +/- 21, 64 +/- 10 ms; p < 0.05). Conduction time was measured at the initiation of VT or VF induced by orthodromic or antidromic pacing. The conduction times of the last paced beat between N-EN and B-EP (35 +/- 11, 62 +/- 24 ms), N-EN and N-EP (35 +/- 12, 14 +/- 13 ms), B-EN and B-EP (16 +/- 10, 38 +/- 25 ms), and B-EP and N-EP (77 +/- 27, 44 +/- 12 ms) were significantly different in dogs with inducible VT (p < 0.05), but not in dogs with VF.(ABSTRACT TRUNCATED AT 250 WORDS)

To determine the influence of timing on the prognostic value of programmed ventricular stimulation after acute myocardial infarction (AMI), 32 patients were studied on day 19 (early study) and again on day 36 (late study) after AMI using up to 3 extrastimuli. At the early study, sustained monomorphic ventricular tachycardia (VT) was induced in 12 patients (38%), sustained polymorphic VT in 8 (25%), nonsustained monomorphic VT in 1 (3%), nonsustained polymorphic VT in 1 (3%) and no inducible arrhythmia in 10 (31%). At the late study, sustained monomorphic VT, nonsustained monomorphic VT and nonsustained polymorphic VT were induced in 8 patients (25%) each, and no inducible arrhythmia in 8 (25%). Of the 12 patients who had inducible sustained monomorphic VT at the early study, 7 had noninducibility of sustained monomorphic VT at the late study. Of the 20 patients who had noninducibility of sustained monomorphic VT at the early study, 3 had inducible sustained monomorphic VT at the late study. During the follow-up period (mean +/- standard deviation 21 +/- 8 months), there were 2 sudden cardiac deaths and 3 occurrences of sustained VT. Univariate analysis revealed both inducibilities of sustained monomorphic VT at the early study (p = 0.045) and at the late study (p less than 0.001) to be predictive of sudden cardiac death or clinical occurrence of sustained VT. However, inducibility of sustained monomorphic VT at the late study had a higher sensitivity (100%), specificity (89%), positive predictive value (63%) and negative predictive value (100%) than at the early study (80, 70, 33 and 95%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

To investigate the effects of intravenous verapamil (V) in coronary thrombolytic therapy, we serially observed the time course of perfusion of the myocardium by 201-thallium (Tl) SPECT in patients who were successfully reperfused within 6 hours from the onset. 201-Tl SPECT was attempted serially on the 1st-2nd day, the 7th-10th day and 28th-30th day. In addition to this, we calculated the count ratio of radioactivity of 99mTc-PYP (CR) in the infarcted myocardium to sternum to evaluate intracellular uptake of calcium during reperfusion. The infarct size, estimated by % Defect decreased significantly in the patients treated with V, while it remained unchanged in the patients without it. In the patients with V, the left ventricular ejection fraction was more favourable, and exercise-induced ischemia determined by redistribution of 201-Tl SPECT in the chronic phase was found more frequently. CR showed no difference between reperfused myocardium irrespective of the treatment. In conclusion, verapamil was considered to enhance myocardial salvage carried out by reperfusion, and not to affect the influx of intracellular calcium into the injured myocytes.

The prognostic significance of sustained monomorphic ventricular tachycardia (VT) induced by programmed ventricular stimulation using up to 3 extrastimuli was evaluated in 133 consecutive survivors of acute myocardial infarction (AMI) at a mean interval of 1.8 +/- 1.1 months after onset. This was compared with hemodynamic and angiographic abnormalities shown by cardiac catheterization and ventricular ectopic activity detected by Holter monitoring. Sustained monomorphic VT was induced in 25 (19%) patients, sustained polymorphic VT in 11 (8%) patients, nonsustained monomorphic VT (greater than or equal to 10 beats) in 12 patients (9%) and nonsustained polymorphic VT in 9 patients (7%). Multivariate logistic regression analysis of clinical, angiographic, hemodynamic and electrocardiographic variables showed that the presence of a left ventricular aneurysm (p = 0.005) and Lown grade 4B ventricular ectopic activity (p less than 0.001) were independent predictors of inducibility of sustained monomorphic VT. During a mean follow-up of 21 +/- 13 months, there were 8 (6%) sudden cardiac deaths and 3 (2.3%) spontaneous occurrences of life-threatening sustained VT. The 2-year probability of freedom from sudden cardiac death or sustained ventricular tachyarrhythmias was 53 +/- 13% for patients with inducible sustained monomorphic VT, 70 +/- 10% for those with a left ventricular ejection fraction less than 40% and 58 +/- 13% for those with Lown grade 4B ventricular ectopic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

To assess the relationships among wall motion abnormality, myocardial ischemia and ST change in patients with myocardial infarction (MI), dobutamine stress thallium (Tl) myocardial scintigraphy, and two-dimensional echocardiography (2DE) and electrocardiography were simultaneously performed. Sixteen patients with anterior MI who underwent 2DE and ECG were studied at baseline and during dobutamine infusion with incremental doses of two to 40 micrograms/kg/min. The stress endpoints were chest pain, significant ST changes, tachycardia (greater than or equal to 110/min), and complicated arrhythmias. At the maximal tolerable dose of dobutamine, Tl scintigraphy was completed, and then repeated again four hours later. Left ventricular wall motion was evaluated using superimposed wall tracings of the configuration on 2DE, and was expressed as regional % area changes. Myocardial ischemia was quantified by SPECT and measured as regional % Tl uptake. Dobutamine stress testing was well tolerated by all patients, and no complications occurred. Hemodynamic changes included: heart rate increased from 61 +/- 9 to 113 +/- 11 beats/min, left ventricular end-diastolic volume (2DE) decreased from 93 +/- 27 to 59 +/- 33 ml, and mean blood pressure and ejection fraction were unchanged. In 11 of the 16 patients, redistributions on planar and SPECT images were observed. Although redistributions were observed in the areas adjacent to infarcts in patients with significant ST elevation in V3, additional wall motion abnormalities were not observed. The shape of the ST elevation had no relation to myocardial ischemia. In some cases, wall motion abnormality can be improved in spite of ischemia. Thus, this new combined method is useful for evaluating the relationship between ischemia and wall motion dynamics.

The region of overlap of thallium-201 (Tl) and technetium-99m pyrophosphate (Tc) was evaluated as a scintigraphic prognosticator of future necrosis. Serial time courses of myocardial perfusion according to Tl and left ventricular wall motion evaluated by two-dimensional echocardiography (2D echo) were used in 22 patients. In all, dual energy emission computed tomography (dual-SPECT) showed the Tl/Tc overlap on identical slices on the third post-infarction day. According to the results of dual-SPECT, the patients were categorized in three groups: nine with large Tl/Tc overlap (group A); five with small Tc accumulation and small Tl/Tc overlap (group B); and eight with large Tl defect and Tc accumulation, which are concordant with each other (group C). Tl-201 SPECT and 2D echo were attempted serially on the 1st and 2nd days, the 7th-10th days and the 28th-30th days. To estimate infarct size with Tl-201 SPECT, we measured pixel counts of eight short-axis images with the 40% cut-off level and computed "% defect". To evaluate the viability of the myocardium, "% Tl uptake" was computed from the ROIs both in the centers of the infarct areas and their border zones. 2D echoes of the left ventricular short axis at the chordae tendineae level were recorded to identify the time course of percent fractional area change (% FAC) of the ischemic left ventricular wall. The scintigraphic results were compared with the serial changes of regional ejection fraction in the areas of infarcts and ischemic lesions. The % defect remained unchanged in group C (29.2 +/- 11.5----25.7 +/- 8.3%); whereas those of groups A and B decreased significantly (21.2 +/- 11.3----9.9 +/- 6.3%, 13.8 +/- 2.6----5.4 +/- 2.9%, respectively). In groups A and B, % FAC improved significantly in the centers of the infarct areas and the border zones, but not in group C. Exercise-induced ischemia determined by redistribution of Tl at the chronic phase was observed more frequently in groups A and B than in group C. These findings indicated that more myocardium can be saved from necrosis in group A than in group C. In conclusion, it is suggested that there is considerable viable myocardium in patients with large Tl/Tc overlap on dual-SPECT.