Reperfusion arrhythmias are associated with epicardial reperfusion but may also be a sign of vascular
reperfusion injury which can be seen as
no-reflow phenomenon on coronary angiography and predicts in-hospital complications and recovery of left ventricular (LV) function.
No-reflow phenomenon (thrombolysis in
myocardial infarction [TIMI] <or=2 flow) is frequently observed in patients after mechanical or medical reperfusion procedures for acute
myocardial infarction (AMI). The authors hypothesized that reperfusion arrhythmias (or peri-
infarct arrhythmias) may be related to continuing
myocardial ischemia. They documented all
arrhythmia episodes in patients with AMI and compared
arrhythmia rates in different
therapy groups. They also compared
arrhythmia rates according to TIMI flow achieved and those after MI. The highest
arrhythmia rate was detected in patients to whom
thrombolytic therapy was given for AMI (64%). The
arrhythmia rate was lower in patients with primary PCI performed for AMI (46.2%) than in those receiving
thrombolytic therapy. The
arrhythmia rates according to
therapy modalities for AMI were significantly different (p < 0.01). The achieved mean TIMI flow with primary PCI (2.46 +/-0.21 ) was higher than the mean flow achieved after
thrombolytic therapy (2.12 +/-0.16). When compared to the
arrhythmia rate according to TIMI
flow, it was shown that the lowest
arrhythmia rate was found in patients with TIMI 3 flow (17.2%) achieved with any procedure after AMI. The
arrhythmia rate was 84% in patients with TIMI 2 flow and 33.3% with TIMI 0-1 flow (p <0.001). The
arrhythmia rate was appreciably lower after 48 hours of MI. This finding suggests that the continuing
myocardial ischemia represented by TIMI flow at the coronary angiography after acute
myocardial infarction may have an important role in the pathogenesis of reperfusion arrhythmias.