JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
 QUICK SEARCH:   [advanced]


     


J Am Coll Cardiol, 1993; 22:1773-1779
© 1993 by the American College of Cardiology Foundation
This Article
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Berger, P.
Right arrow Articles by Podrid, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Berger, P.
Right arrow Articles by Podrid, P.

Incidence and significance of ventricular tachycardia and fibrillation in the absence of hypotension or heart failure in acute myocardial infarction treated with recombinant tissue-type plasminogen activator: results from the Thrombolysis in Myocardial Infarction (TIMI) Phase II trial

PB Berger, NA Ruocco, TJ Ryan, MM Frederick, and PJ Podrid

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.

OBJECTIVES. The purpose of this study was to determine the incidence of ventricular tachycardia and fibrillation without hypotension or heart failure after treatment with recombinant tissue-type plasminogen activator (rt-PA), anatomic correlates of their development, the effect of immediate intravenous metoprolol on their occurrence and the outcome of patients with these arrhythmias. BACKGROUND. Malignant arrhythmias after thrombolytic therapy have been reported to occur as a result of coronary reperfusion, which is associated with reduced mortality in patients receiving thrombolytic therapy. METHODS. We analyzed data from 2,546 patients in the Thrombolysis in Myocardial Infarction (TIMI) Phase II trial without congestive heart failure or hypotension during the 1st 24 h after study entry. Forty-nine patients (1.9%) developed sustained ventricular tachycardia or ventricular fibrillation within 24 h of study entry (group 1), and 2,497 patients (98.1%) did not (group 2). RESULTS. Baseline characteristics and admission laboratory values were similar in the two groups. In patients undergoing protocol angiography 18 to 48 h after rt-PA, the infarct-related artery was patient in a greater percent of group 2 patients (87% [1,015 of 1,169]) than group 1 patients (68% [15 of 22], p = 0.01), although angiography was performed less frequently in group 1 than in group 2. More group 1 than group 2 patients died within 21 days (20.4%) (1.6%, p < 0.001). For patients surviving to 21 days, there was no difference in mortality between patients in the two groups in the following year. CONCLUSIONS. Ventricular tachycardia and fibrillation are not markers for reperfusion after thrombolytic therapy. These arrhythmias are associated with occlusion, not patency, of the infarct-related artery. Early mortality is increased in patients who develop ventricular tachycardia and fibrillation, even in the absence of congestive heart failure and hypotension.


This article has been cited by other articles:


Home page
CirculationHome page
G.-X. Yan, A. Joshi, D. Guo, T. Hlaing, J. Martin, X. Xu, and P. R. Kowey
Phase 2 Reentry as a Trigger to Initiate Ventricular Fibrillation During Early Acute Myocardial Ischemia
Circulation, August 31, 2004; 110(9): 1036 - 1041.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
R. H. Mehta, K. J. Harjai, L. Grines, G. W. Stone, J. Boura, D. Cox, W. O'Neill, C. L. Grines, and Primary Angioplasty in Myocardial Infarction (PAMI
Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention: Incidence, predictors, and outcomes
J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1765 - 1772.
[Abstract] [Full Text] [PDF]


Home page
NEJMHome page
P. J. Zimetbaum and M. E. Josephson
Use of the Electrocardiogram in Acute Myocardial Infarction
N. Engl. J. Med., March 6, 2003; 348(10): 933 - 940.
[Full Text] [PDF]


Home page
HeartHome page
K Foo, N Sekhri, A Deaner, C Knight, A Suliman, K Ranjadayalan, and A D Timmis
Effect of diabetes on serum potassium concentrations in acute coronary syndromes
Heart, January 1, 2003; 89(1): 31 - 35.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
J.M van der Vlugt, H Boersma, C.M Leenders, G.A.M Pop, M.J Veerhoek, M.L Simoons, and J.W Deckers
Prospective study of early discharge after acute myocardial infarction (SHORT)
Eur. Heart J., June 2, 2000; 21(12): 992 - 999.
[Abstract] [PDF]


Home page
J Am Coll CardiolHome page
P. J. Gheeraert, J. P. S. Henriques, M. L. De Buyzere, J. Voet, P. Calle, Y. Taeymans, and F. Zijlstra
Out-of-hospital ventricular fibrillation in patients with acute myocardial infarction: Coronary angiographic determinants
J. Am. Coll. Cardiol., January 1, 2000; 35(1): 144 - 150.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
K. H. Newby, T. Thompson, A. Stebbins, E. J. Topol, R. M. Califf, and A. Natale
Sustained Ventricular Arrhythmias in Patients Receiving Thrombolytic Therapy : Incidence and Outcomes
Circulation, December 8, 1998; 98(23): 2567 - 2573.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
J. A. Barrabes, D. Garcia-Dorado, M. A. Gonzalez, M. Ruiz-Meana, J. Solares, Y. Puigfel, and J. Soler-Soler
Regional expansion during myocardial ischemia predicts ventricular fibrillation and coronary reocclusion
Am J Physiol Heart Circ Physiol, May 1, 1998; 274(5): H1767 - H1775.
[Abstract] [Full Text] [PDF]


Home page
JWatch GeneralHome page
VENTRICULAR ARRHYTHMIAS AFTER THROMBOLYSIS ARE A WARNING SIGN
Journal Watch (General), December 14, 1993; 1993(1214): 3 - 3.
[Full Text]




HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 1993 by the American College of Cardiology Foundation.