Prospective evaluation of where reperfusion ventricular arrhythmia “bursts” fit into optimal reperfusion in STEMI

Abstract

PREPARE: ISRCTN71104460 http://www.controlled-trials.com/ISRCTN71104460.

Ischemia/Reperfusion Injury following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists

“…VAs upon reperfusion have been recognized since the advent of recanalization techniques [ 152 ]; however their pathophysiological and prognostic significance is still controversial [ 153 ]. Several arrhythmogenic mechanisms have been proposed to be involved in IRI-induced arrhythmias [ 154 , 155 ].…”

“…Several arrhythmogenic mechanisms have been proposed to be involved in IRI-induced arrhythmias [ 154 , 155 ]. Some of VAs that occur almost directly at the moment of reperfusion (namely, ventricular premature beats and accelerated idioventricular rhythms) are usually harmless and well tolerated [ 152 ]; however it has been reported that ventricular tachycardia and ventricular fibrillation occurring immediately after reperfusion remain the most important causes of sudden death following restoration of blood flow [ 156 , 157 ].…”

Editor’s Choice- Reperfusion cardiac arrhythmias and their relation to reperfusion-induced cell death

“…This connection is supported by previous findings by our group. [3][4][5][6][7][8][9] We found, in several independent cohorts, the presence of a 'burst' of ventricular reperfusion arrhythmias (VA burst) to be related to clinically significant larger infarct size. This increase remained while correcting for other known factors of increased infarct size.…”

“…reopening of the infarct vessel, more recent studies have shown that reperfusion without arrhythmias resulted in smaller infarcts in spite of equal initial areas at risk. [3][4][5][6][7][8]…”

Reperfusion ventricular arrhythmia bursts identify larger infarct size in spite of optimal epicardial and microvascular reperfusion using cardiac magnetic resonance imaging

“…2 A statistical objectification of these reperfusion VAs, in which they were quantified against a subject-specific background VA rate as a new 'burst' of VA following angiographic recanalisation of the infarct artery, has confirmed these findings. [3][4][5][6][7] The involvement of microvascular obstruction (MVO) in the pathogenesis of VA burst is unknown. MVO is a known marker of additional extensive injury and larger IS, worse left ventricle ejection fraction (LVEF), left ventricle (LV) remodelling and a higher incidence of cardiovascular complications.…”