[Reperfusion arrhythmias during coronary thrombolysis: clinical reality or experimental curiosity?]

Abstract

To determine the arrhythmogenic impact of the fibrinolytic therapy during acute myocardial infarction, we have revised 9 clinical series published between 1983 and 1992 including a total number of 2,091 patients, and we have discussed the data according to the factors that modulate the incidence of reperfusion arrhythmias. All patients had an acute myocardial infarction that began 3 to 6 hours before admission and in all instances fibrinolytic treatment consisted of intravenous or intracoronary streptokinase infusion. Ventricular fibrillation (VF) during thrombolytic therapy occurred in 8 (4%) out of 188 patients with angiographically documented reopening of the occluded coronary artery. The mean incidence of VF was 0-17% among all series. The overall incidence of sustained ventricular tachycardia (VT) was 19%, whereas that the incidence of slow VT (idioventricular rhythm) was 39%. Sinus bradycardia was not systematically analyzed in the present series, but the presence of sinus bradycardia and arterial hypotension (Bezold-Jarisch reflex) was considered to be indicative of myocardial reperfusion specially in cases of acute inferior myocardial infarction. We conclude that in contrast to experimental models of coronary reperfusion, fibrinolytic therapy in patients with acute myocardial infarction has a low arrhythmogenic potential.