ELECTRICAL INSTABILITY OF MYOCARDIUM IN INFARCTION PATIENTS AND ITS PROGNOSTIC SIGNIFICANCE

Aim. To find out the significance of different signs of electric instability in acute myocardial infarction patients for on time prediction of in-patient course and adverse outcome by the next year.

Material and methods. 98 men studied, with acute Q-infarction. For electrical instability assessment at hospital stage Holter monitoring was done of high resolition ECG on 1st, 7th day and at discharge.

Results. It is found that in-hospital course can be forecasted by the following data from acute phase: presence of dangerous ventricluar extrasystoli, ventricular and atrial tachicardias paroxysms, decrease of circadian index of heart rate <1,06 (risk of complications) and <0,98 (risk of fatal outcome), prolonged QTc >473 ms (complications risk) and >498 ms (fatal outcome risk), onset of delayed ventricular potentials. We developed the probable predictors of the range of adverse events for in-patient period that is important for any patient management. It is proved, that fatal outcome risk in katamnesis does increase if in-patient period is complicated by left ventricle failure, if frequent ventricular extrasystoli develop or frequent paroxysms of ventricular and supraventricular tachicardia, with absence of significant decrease of dangerous ventricular extrasystoli on further monitors, as in absence of positive dynamics at in-patient stage (from the first to the second monitor) of the values of the following parameters of electrical instability of myocardium: increase of low pNN50 and shortening of prolonged QTc and its dispersion.

Conclusion. Prediction of complicated course of acute myocardial infarction and adverse outcome during the first year can be grounded on complex analysis of the parameters of electrical instability and arrhythmic activity of myocardium by the data of triple Holter monitoring of electrocardiogram of high resolution during in-hospital period, and the best predictive value have data from acute period and its dynamics.

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