In animal studies reperfusion of coronary arteries is commonly accompanied by ventricular arrhythmias. It is not certain, however, whether ventricular arrhythmias can be used as a reliable non-invasive marker of reperfusion in humans. Two-channel In humans, however, some of the arrhythmias seen in the first hours after the onset of infarction can be attributed to the inherent electrical instability of the ischaemic myocardium and not to reperfusion. To investigate the difference between "infarction arrhythmias" and "reperfusion arrhythmias", we need to measure the patency rate of the infarct-related coronary artery and disorders of the heart rhythm within a well-defined interval.We therefore determined the predictive value of ventricular arrhythmias for patency of the infarct-related vessel in patients with acute transmural infarction by monitoring the heart rhythm with Holter recording from the start of streptokinase administration until angiographic visualisation of the infarctrelated vessel up to four hours later (that is, the study period). Patients and methods PATIENTSFifty seven patients with acute myocardial infarction were treated with intravenous streptokinase. We studied male and female patients below the age of 71 years with symptoms of acute myocardial infarction for less than four hours and ST segment elevation of > 1 mm in at least two leads of the standard 12 lead electrocardiogram. We excluded patients with a history of abnormal bleeding, use of anticoagulant drugs, recent surgery (<2 weeks), previous cerebral haemorrhage or injury, impaired renal function (serum creatinine concentration > 300 ymol/l), systolic blood pressure > 200 mm Hg, diastolic > 120 mm Hg, severe heart failure with pulmonary congestion on admission, any malignancy (except those of the skin), or previous treatment with streptokinase.
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