Early Reperfusion During Acute Myocardial Infarction Affects Ventricular Tachycardia Characteristics and the Chronic Electroanatomic and Histological Substrate

Background-Reperfusion therapy during acute myocardial infarction results in myocardial salvage and improved ventricular function but may also influence the arrhythmogenic substrate for ventricular tachycardia (VT). This study used electroanatomic mapping and infarct histology to assess the impact of reperfusion on the substrate and on VT characteristics late after acute myocardial infarction. Methods and Results-The study population consisted of 36 patients (32 men; age, 63 +/- 15 years) referred for treatment of VT 13 +/- 9 years after acute myocardial infarction. Fourteen patients with early reperfusion during acute myocardial infarction were compared with 22 nonreperfused patients. Spontaneous and induced VTs and the characteristics of electroanatomic voltage maps were analyzed. Twenty-seven patients were treated by radiofrequency catheter ablation. Ten patients (6 nonreperfused) were treated by ventricular restoration with intraoperative cryoablation in 9. During surgery, biopsies were obtained from the resected core of the infarct. VT cycle length of spontaneous and induced VTs was shorter in reperfused patients (reperfused, 299 +/- 52/270 +/- 58 ms; nonreperfused, 378 +/- 77/362 +/- 74 ms; P=0.01). An electroanatomic patchy scar pattern was present in 71% of reperfused and 14% of nonreperfused patients (P=0.004). The proportion of electroanatomic dense scar was smaller in reperfused patients (24 +/- 18% versus 45 +/- 21%; P=0.02). Histological assessment in 10 patients revealed thick layers of surviving myocardium in 75% of reperfused but in none of the nonreperfused patients. Conclusions-Scar size and pattern defined by electroanatomic mapping are different between VT patients with and without reperfusion during acute myocardial infarction. Less confluent electroanatomic scars match with thick layers of surviving myocardium on histology. Early reperfusion and less confluent electroanatomic scar are associated with faster VTs. (Circulation. 2010;121: 887-1895.)