Ventricular arrhythmias in trials of thrombolytic therapy for acute myocardial infarction. A meta-analysis

Although thrombolytic therapy reduces long-term mortality in acute myocardial infarction, many clinicians remain concerned about an increased risk of ventricular arrhythmias associated with the use of these agents.

To determine whether thrombolytic therapy increases the risk of ventricular tachyarrhythmias and whether an increase in arrhythmias could be responsible for the increased mortality seen in the first 24 hours after lytic therapy, we performed a meta-analysis of 15 randomized trials of thrombolysis in acute myocardial infarction in which the odds of developing in-hospital ventricular fibrillation (VF) and ventricular tachycardia (VT) in patients receiving thrombolysis was compared with that of patients receiving placebo. For trials that reported the incidence of VF during the first 6 hours after thrombolysis, the summary odds ratio for developing VF in the thrombolytic group was 0.98 (95% confidence interval [CI], 0.6 to 1.6; P = .94). For trials that reported the incidence of VF during the first hospital day, the summary odds ratio for developing VF was 1.00 (95% CI, 0.85 to 1.2; P = .95). The summary odds ratio for the development of VF at any time during hospitalization in the thrombolytic group was 0.83 (95% CI, 0.76 to 0.90; P < .0001). In trials that reported the incidence of VT any time during hospitalization, the summary odds ratio for the development of VT in the thrombolytic group was 1.34 (95% CI, 1.15 to 1.55; P < .0001).

The likelihood of developing VF in the early hours after thrombolysis for acute myocardial infarction is similar in patients receiving thrombolytics or placebo. However, throughout the hospital course, the risk of VF is greater in patients receiving placebo, whereas the risk of VT is higher in patients receiving thrombolysis.