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Relationships among Ventricular Arrhythmias, Coronary Artery Disease, and Angiographic and Electrocardiographic Indicators of Myocardial Fibrosis

SUMMARYThis study was performed to determine the relationships among angiographic, hemodynamic, clinical, and electrocardiographic data and premature ventricular contractions (PVCs). Arrhythmias were analyzed by 24 hour Holter monitor in 244 patients evaluated for chest pain by coronary angiography and left ventriculography. Using a categorical linear model, the presence of myocardial fibrosis as indicated by both abnormal left ventricular contraction (LVC) and abnormal initial QRS on electrocardiogram was found to be the only independent predictor of both frequent and complex ventricular arrhythmias (P < .0001). All other descriptors, including the number of diseased vessels (.75% obstruction), were dependent upon abnormal LVC in their association with PVCs. When the right anterior oblique view of the left ventriculogram was divided into nine segments to allow automated quantitative analysis of LVC, the prevalence of frequent PVCs was directly related to the number of abnormally contracting segments. Of patients with 0 abnormal segments, 11% had > 2 PVC/hr, in contrast to 44%, 73% and 100% of patients with 1-3, 4-6, and 7-9 abnormal wall segments, respectively (P < 0.01). A similar quantitative relationship was found between premature ventricular contractions and abnormal initial forces indicating previous myocardial infarction on the electrocardiogram.