Predictive value of ventricular arrhythmias for patency of the infarct-related coronary artery after thrombolytic therapy.

Abstract

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.

Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention

“…Importantly, it shows that although the occurrence of VT/VF during primary angioplasty is associated with a greater length of stay, it does not have an impact on the procedural success or risk of adverse in-hospital and long-term outcomes. Thus, our study findings are in contrast to those of large trials evaluating VT/VF in patients with STEMI receiving thrombolytic therapy, which have reported a higher incidence of up to 20% and a greater risk of adverse short-and long-term outcomes with this arrhythmia (1)(2)(3)(4)(5)(6). Previous studies have shown that the size of myocardial infarction not only correlates with an increased incidence of VT/VF, but is also an important predictor of mortality in patients with STEMI (5,6,16 -18).…”

“…Some of these investigations have suggested that these ventricular arrhythmias are associated with coronary reperfusion, although others have related them to suboptimal reperfusion (1)(2)(3)(4)(5)(6). The occurrence of VT/VF after thrombolysis has been shown to be associated with an increased risk of in-hospital and one-year adverse events (6).…”

“…Many studies have investigated the clinical and angiographic correlates and the prognostic significance of sustained ventricular tachycardia and/or ventricular fibrillation (VT/VF) after thrombolytic therapy in patients with STsegment elevation myocardial infarction (STEMI) (1)(2)(3)(4)(5)(6).…”

Prognosis and Treatment of Ventricular Arrhythmias Following Myocardial Infarction

“…Studies in the thrombolytic era have suggested that AIVR is a marker of reperfusion following thrombolytic therapy [26][27][28][29], although this has debated in the literature [29][30][31]. Explanations for these differences include the definition of AIVR used, the possible failure to record "benign" arrhythmias, the use of both intracoronary and intravenous thrombolytics, and the use of lidocaine in some trials [27].…”

“…Explanations for these differences include the definition of AIVR used, the possible failure to record "benign" arrhythmias, the use of both intracoronary and intravenous thrombolytics, and the use of lidocaine in some trials [27]. Overall, the presence of AIVR is considered an indicator of reperfusion with a specificity as high as 93% [32], although the absence of AIVR does not exclude reperfusion of the infarctrelated artery (low sensitivity) [26,27].…”