Author + information
- Received June 15, 1992
- Revision received July 15, 1993
- Accepted July 26, 1993
- Published online December 1, 1993.
- Peter B. Berger, MD, FACCa,∗,
- Nicholas A. Ruocco, MD, FACCa,
- Thomas J. Ryan, MD, FACCa,
- Margaret M. Frederick, PhDb and
- Phillip J. Podrid, MD, FACCa,c,‡
- ↵∗Address for correspondence: Dr. Peter B. Berger, Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Objectives. The purpese of this study was to determine the incidence of ventriculer 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 analysed 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 laboraratory values were similar in the two groups. In patients undergoing protocol angiography 18 to 48 h after rt-PA, the infarct-related artery was patent 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.
- Received June 15, 1992.
- Revision received July 15, 1993.
- Accepted July 26, 1993.