Anterior Stemi w/ successful ppci then develop self limiting vfib?

Editorial Team / Admin · Sep 4, 2023

We don't know what damage may have been done before the (presumably successful??) PCI opened up the artery (-ies??) again. There may have been damage to electrical pathways that precipitated the Vfib. Post-PCI arrhythmias are not uncommon.

Here is an interesting article discussing development of CTO post-PCI self-limiting Vfib: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166392/

Also, another article about post-MI Vfib development: https://www.uptodate.com/contents/ventricular-arrhythmias-during-acute-myocardial-infarction-incidence-mechanisms-and-clinical-features

and a quote from the second article: "The appearance of a sustained ventricular tachyarrhythmia following an MI, such as ventricular tachycardia (VT) or ventricular fibrillation (VF), in the early period post-MI may be the harbinger of ongoing myocardial ischemia, the development of proarrhythmic myocardial scar tissue, elevated sympathetic tone or increase in circulating catecholamines, or an electrolyte disturbance such as hypokalemia. In-hospital mortality approaches 20 percent or more in patients who develop VT or VF following an MI. As such, rapid identification and treatment of these arrhythmias can be life-saving. Although all patients with a prior MI have an elevated risk of malignant arrhythmias, the magnitude of risk varies from patient to patient, with reduced left ventricular ejection fraction being the most prominent risk stratifier." (emphasis mine)

As this patient had EF of 40%, the life vest sounds like a prudent move (pending Electrophysiologist review and examination of patient).

ambersky004, BSN, RN · Sep 4, 2023

Thank you dianah

Advanced Practice Columnist / Guide · Jan 9

Post MI Vfib is not uncommon. In post MI, the criteria for ICD implantation is an EF of less than 30%. I don't know what this patient's EF is prior to the MI, is the low EF a consequence of this MI? In that case, the rule is to observe over a few months after revascularization with a stent and with medical therapy (DAPT, BB, ACE, statin) and see if the EF recovers and if not then an ICD implantation is indicated (this would qualify the patient's low EF as due to ischemic cardiomyopathy). I think the Cardiologist is not wrong for recommending a vest. He is not committing to a permanent device but wants to make sure the patient has a way to protect himself if a life threatening VF should occur while at home.