Reperfusion arrhythmia: myth or reality?

Early reports of "reperfusion arrhythmia" after experimental temporary coronary occlusion raised concern that these arrhythmias, particularly ventricular fibrillation and ventricular tachycardia, might occur in association with reperfusion of an occluded coronary vessel during thrombolysis. Such an occurrence could increase the risk of transfer of such patients. To provide a more definitive answer to this question, we reviewed hospital and transfer records for all patients with acute myocardial infarction transferred by our critical care transfer service between January 1, 1985, and November 30, 1987, noting the occurrence of five types of arrhythmia: ventricular fibrillation, ventricular tachycardia, premature ventricular contractions, bradycardia, and atrioventricular block, both before and during transfer. Five hundred patients with acute myocardial infarction less than 48 hours old were transferred during this period. Two hundred twenty-five patients received thrombolytic therapy; 270 did not (five unknown). The type of acute myocardial infarction was known for 471 patients: 192 were anterior, 203 were inferior, and 76 were lateral. There were no deaths during transfer. Overall survival through hospitalization was 91%. The incidence of arrhythmia was 36% before transport and 12% during transport. There was no difference in arrhythmias overall, or with respect to any of the five arrhythmias specified, between patients who received thrombolytic therapy before and during transport and those who did not. Reperfusion arrhythmia does not appear to be a clinically significant entity during the transport of patients who are receiving IV thrombolytic therapy.