The effect of neutrophil depletion on reperfusion arrhythmias during intracoronary thrombolysis using the leukocyte removal filter.

Abstract

To evaluate the effects of neutrophil depletion on reperfusion arrhythmias using a leukocyte removal filter (LRF), the authors examined several cardiovascular variables in three patients with myocardial infarction who underwent successful thrombolytic therapy with LRF compared with control patients without LRF. Coronary angiography performed within 4 hr of onset revealed total occlusion in the proximal segment of the left anterior descending (LAD) coronary artery, without collaterals, in all patients. Thrombolysis was performed by intracoronary administration of urokinase (10,000 IU/ml, 1,000,000 IU total) mixed with filtered autologous blood. LRF was composed of a nonwoven polyester fabric (1.8 microns, 4.6 g). Removal rates of leukocytes and platelets by LRF were 98-100% and 98%, respectively. Average duration of the ischemic episodes, maximum ST segment elevation, and integral of T segment depression did not differ in the two groups. However, the frequency of ventricular premature beats (VPB) during the first 30 min after reperfusion were significantly lower in the LRF treatment group (3.8%) compared with the control group (10.7%). Segmental shortening, measured by echocardiography one hour after recanalization, exhibited higher values in the LRF treated patients than control patients, without significant difference. Data suggested that LRF is effective in reducing reperfusion arrhythmias during intracoronary thrombolysis and activated neutrophils may play an important role in stunned myocardium.