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Reduction in the frequency of ventricular late potentials after acute myocardial infarction by early thrombolytic
M Zimmermann1, R Adamec, S Ciaroni
1Cardiology Center, Policlinic of Medicine, University Hospital, Geneva, Switzerland.
Insights
Intravenous thrombolysis reduced ventricular late potentials, a predictor of arrhythmias, in acute myocardial infarction survivors. This suggests thrombolysis may improve outcomes by decreasing these electrical abnormalities.
Area of Science:
- Cardiology
- Electrophysiology
- Acute Myocardial Infarction Research
Background:
- Ventricular late potentials (VLPs) are significant predictors of arrhythmic events post-acute myocardial infarction (AMI).
- Intravenous thrombolysis is a critical treatment for AMI, but its effect on VLP incidence requires further assessment.
Purpose of the Study:
- To evaluate the impact of intravenous thrombolysis on the occurrence of ventricular late potentials in patients surviving their first AMI.
- To compare VLP incidence between patients receiving thrombolysis and those receiving conventional medical treatment.
Main Methods:
- A cohort of 223 AMI survivors was studied.
- Group A (n=59) received intravenous recombinant tissue-type plasminogen activator; Group B (n=164) received conventional treatment.
- Signal-averaged electrocardiograms were performed 10 days post-AMI to detect VLPs.
Main Results:
- The incidence of VLPs was significantly lower in the thrombolysis group (10%) compared to the conventional treatment group (24%, p<0.05).
- No significant differences were observed in AMI location, left ventricular ejection fraction, or heart failure presence between groups.
- Among patients with coronary arteriography, VLPs were less frequent with a patent infarct-related artery (13%) versus an occluded artery (26%, p<0.05).
Conclusions:
- Intravenous thrombolysis is associated with a reduced incidence of ventricular late potentials after acute myocardial infarction.
- The findings suggest that thrombolysis may mitigate the risk of arrhythmias by decreasing VLP formation.
- Maintaining infarct-related artery patency is also linked to a lower incidence of VLPs.
Abstract:
Ventricular late potentials are strong predictors of arrhythmic events after acute myocardial infarction (AMI). To assess the effect of intravenous thrombolysis on the incidence of ventricular late potentials, 223 consecutive patients surviving a first AMI were included in the present study: 59 patients (53 men, 6 women, mean age +/- standard deviation 55 +/- 10 years) received intravenous recombinant tissue-type plasminogen activator (100 mg over 3 hours, group A) and 164 patients (123 men, 41 women, mean age 61 +/- 11 years) received conventional medical treatment (group B). A time-domain signal-averaged electrocardiogram and a high-resolution beat-to-beat recording (gain 10(6), filters 100 to 300 Hz) were performed at 10 +/- 3 days after AMI. There was no difference between group A and B patients in terms of AMI location (anterior in 28 of 59 vs 80 of 164, difference not significant [NS]), mean left ventricular ejection fraction (55 +/- 10 vs 55 +/- 13%, NS), or presence of heart failure (New York Heart Association class III or IV in 12 of 59 vs 40 of 164, NS). The incidence of ventricular late potentials was 10% (6 of 59) in group A and 24% (39 of 164) in group B (p less than 0.05). Among the 146 patients who underwent coronary arteriography, the incidence of ventricular late potentials was 13% (10 of 80) in patients with a patent infarct-related artery and 26% (17 of 66) in patients with an occluded infarct-related artery (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)