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European Heart Journal 1993 14(4):516-520;
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The European Society of Cardiology

Is arrhythmogenicity related to the speed of reperfusion during thrombolysis for myocardial infarction?

V. GRESSIN, A. P. M. GORGELS*, Y. LOUVARD, H. LARDOUX and R. H. BIGELOW{dagger}

Cardiology Department, Gilles de Corbeil Hospital Corbeil-Essonnes, France
*Cardiology Department, Academic Hospital, Maastricht The Netherlands
{dagger}Biometrics Department Du Pont Pharma, Geneva, Switzerland

Received 6 March 1992; revised 27 August 1992; .

Correspondence: virginie Gressin, MD, Cardiology Department (Dr Lardoux). Gilles de Corbeil Hospital, 59 boulevard Henri Dunant, 91100 Corbeil-Essonnes, France.

Abstract

The objective of this study was to relate the number of ventricular arrhythmias (VA) to the normalization time of the ST segment during thrombolysis for acute myocardial infarction. The 24 h Holter recordings, begun on start of intravenous thrombolytic therapy, and the 12-lead electrocardiograms of 41 patients with a patent infarct-related artery according to coronary angiography were analysed. The mean time from onset of chest pain to angiography was 30.5±3.1 h, ≥24 h in 59%. The normalization time of the ST segment, assessed by the time of decrease of ST segment elevation from start of Holter recording to normal or steady state was ≥60 min in 13 patients (group 1), 60 to 180 min in 15 patients (group 2) and > 180 min in 13 patients (group 3). The incidence of VA was similar in all groups, except for ventricular tachycardias (VT) >15 beats (group 1:69%, group 2:13%, group 3:15%, P=0.002) The frequency of accelerated idioventricular rhythms (AIVR), early AIVR (≤6 h) and of VT was significantly higher in group 1 than in group 3 with a 8-, 30- and 6- fold increase, respectively (back transformed mean). We conclude that the number of V As is related to the normalization time of the ST segment during reperfusion. This may suggest that faster reflow is more arrhythmogenic.

Key Words: Acute myocardial infarction • thrombolytic therapy • Holter recording • ventricular arrhythmias • ST segment • reperfusion


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