Seasonality of Ventricular Fibrillation at First Myocardial Infarction and Association with Viral Exposure

PONE-D-19-29659

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Reviewer #1: The authors should be congratulated for this excellent work. Even if the results are negative, the tested hypothesis is of major importance and those findings will be helpful for appropriately guide future research in the field. In the study, the authors examine the influence of seasonality and association of increased enterovirus and influenza activity in the community with the risk of ventricular fibrillation (VF) during first ST-elevation myocardial infarction. Based on a large STEMI cohort and on individual-level linkage of data from Danish nationwide registries, they identified all consecutive STEMI patients admitted to acute angiography and Primary PCI (PPCI) at Rigs Hospitalet Copenhagen between January 2010 and October 2016. The cohort where linked to information on monthly/weekly surveillance data on entro - and influenza virus from the Danish National Microbiology Database. Of 4659 consecutively enrolled STEMI patients, 581 (12%) had VF before PPCI. The VF patients experienced more fatigue and flu-like symptoms 7 days prior to the STEMI event than the non-VF patients from the cohort, but no significant association between enterovirus, week-number and influenza virus exposure

was found. Based on the results the authors conclude that there was no seasonality during STEMI, and that there were no relationship between enterovirus and influenza virus exposure and occurrence of VF before PPCI in STEMI patients. The topic is of great interest since SCA still accounts for more than half of cardiovascular mortality, and because acute coronary artery disease represents the majority of underlying causes. Methodology is robust, paper very well written. Although findings are negative they add substantially to the literature and undoubtedly will help others to go forward in this field.

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Reviewer #1: No