Usefulness of reperfusion ventricular arrhythmias in non-invasive prediction of early reperfusion and sustained coronary artery patency in acute myocardial infarction.

Abstract

Established tenets of occurrence of reperfusion ventricular arrhythmias in acute myocardial infarction (AMI) do not provide insight into the timing of achieving reperfusion or whether coronary artery patency is sustained. We assessed the significance of ventricular arrhythmias in the non-invasive prediction of timely reperfusion and sustained restoration of coronary patency after thrombolysis in patients with AMI. 24-hour Holter monitors were placed in 163 patients with an AMI before administration of thrombolytic therapy. Patients were classified into 3 groups of early (within 2 hours) or late reperfusion, or no-reperfusion, according with clinical and continuous ST-segment electrocardiographic criteria. Ventricular fibrillation, ventricular tachycardia (VT) and accelerated idioventricular rhythm (AIVR) were also categorized as having occurred early (within the first 2 hours) or late (after the first 2-hour period). Angiographic confirmation of coronary patency was determined 2 to 6 days after AMI. Early reperfusion was predicted by early sustained AIVR in 86% of patients and early non-sustained AIVR in 62.5% of patients, with sensitivity 38% and 77%, and specificity 96% and 69%, respectively; p<0.0001. Late non-sustained AIVR was commonly seen in early and late reperfused patients (92-97%) as well as in non-reperfused patients (74%). Sustained coronary patency was predicted by early sustained AIVR in 93% of patients, as well as by early non-sustained AIVR in 86% of patients and late non-sustained AIVR in 79% of patients, with sensitivity 22%, 55% and 94%, and specificity 95%, 71% and 18%, respectively; p<0.05. Only the occurrence of sustained AIVR, and probably early non-sustained AIVR convey useful information about both early reperfusion and sustained coronary artery patency. The absence of AIVR does not preclude successful thrombolysis.