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Inferior myocardial infarction scars could be more arrhythmogenic than anterior ones.

Pascale et al. 1 reported that the scars of old inferior infarctions without areas of potential ischaemia and accompanied by, on average, even better left ventricular systolic function were significantly more associated with the occurrence of ventricular arrhythmias than anterior scars. The authors proposed that the right ventricle damage and sympathetic hyperactivity due to the destruction of afferent vagal fibres in the inferior infarctions may be underlying mechanisms. However, there is an observation2 suggesting a temporary 6-week impairment of cardiac parasympathetic activity associated with anterior infarctions and preserved parasympathetic function in inferior infarctions which conflicts with the latter mechanism Pascale et al. have proposed. Several additional mechanisms should also be considered.

It has been generally accepted …