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CHANGE OF ARRHYTHMIC EVENTS IN ACUTE MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION AFTER PHARMACOINVASIVE REVASCULARIZATION

https://doi.org/10.20996/1819-6446-2017-13-1-25-30

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Abstract

Aim. To study changes in course of arrhythmias, depending on the efficacy of coronary blood flow restoration due to pharmacoinvasive revascularization in patients with ST segment elevation myocardial infarction (STEMI).

Material and methods. STEMI-patients (n=117) with an effective (according to ECG criteria) thrombolytic therapy (TLT) and the subsequent (after 3-24 hours) percutaneous coronary  intervention (PCI), were included into the study. Telemetry ECG was performed before  and after PCI with analysis of the arrhythmias and cardiac conduction disorders.

Results. Patients (n=84; 71.8%) with an effective TLT, confirmed by the coronary angiography (CAG), and with subsequent effective PCI were included into the group "without rethrombosis" (RT(–)). Patients (n=33; 28.2%) with CAG proven rethrombosis of the infarct-related coronary artery and subsequent effective PCI were included into the group "with rethrombosis" (RT(+)). Regardless of the stability of coronary blood flow restoration after the TLT, PCI was associated with an increased incidence of ventricular tachycardia (VT) (p<0.01), sinus tachycardia (p=0.01), paroxysmal supraventricular tachycardia (SVT) (p<0.05) and paired ventricular extrasystoles (p<0.01). Compared to the RT(–) group, in the RT(+) group after PCI VT were recorded more frequently (44% vs 63.6%, respectively; p<0.05) as well as AV-block 3 degree (3.6% vs 12.1%, respectively; p<0.05). Episodes of sinus tachycardia were detected significantly more frequently before PCI in RT(–) group compared with RT(+) group (67.9% vs 45.4% respectively; p<0.01). The number of patients with episodes of sinus bradycardia increased (from 19% to 32.1%; p=0.02) after PCI in RT(–) group.

Conclusion. The incidence of VT and SVT paroxysms, episodes of sinus tachycardia, atrioventricular conduction disturbances and ventricular extrasystoles increased in all patients after the effective PCI due to reperfusion. However, VT episodes and paroxysmal atrioventricular block grade 3 were more common in patients with previous re-thrombosis of the infarct-related coronary artery. Considering a high risk of arrhythmic events, continuous ECG mon itoring with automated alarm systems  about life-threatening arrhythmias should be applied in STEMI patients regardless of tactics of coronary  blood flow restoration and the reperfusion effectiveness.

About the Authors

V. E. Oleynikov
Penza State University
Russian Federation

Valentin E. Oleynikov – MD, PhD, Professor, Head of Chair of Therapy, Medical Institute.

Lermontova ul. 3, Penza, 440026 



E. A. Shigotarova
Penza State University; Penza Regional Clinical Hospital named after N.N. Burdenko
Russian Federation
Ekaterina A. Shigotarova – MD, PhD, Cardiologist, PRCH named after N.N. Burdenko; Assistant, Chair of Therapy, Medical Institute PSU.Lermontova ul. 3, Penza, 440026; Lermontova ul. 28,  Penza, 440026


A. V. Kulyutsin
Penza State University; Penza Regional Clinical Hospital named after N.N. Burdenko
Russian Federation

Aleksey V. Kulyutsin – MD, PhD, Head of Department of Cardiology with the Intensive Care Unit PRCH named after N.N. Burdenko; Assistant Professor, Chair of Therapy, Medical Institute PSU.

Lermontova ul. 3, Penza, 440026; Lermontova ul. 28,  Penza, 440026



E. V. Dushina
Penza State University
Russian Federation

Elena V. Dushina – MD, Assistant, Chair of Therapy, Medical Institute.

Lermontova ul. 3, Penza, 440026 



J. A. Guskova
Penza State University
Russian Federation

Julia A. Guskova – MD, Assistant, Chair of Therapy, Medical Institute.

Lermontovaul. 3, Penza, 440026 



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For citation:


Oleynikov V.E., Shigotarova E.A., Kulyutsin A.V., Dushina E.V., Guskova J.A. CHANGE OF ARRHYTHMIC EVENTS IN ACUTE MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION AFTER PHARMACOINVASIVE REVASCULARIZATION. Rational Pharmacotherapy in Cardiology. 2017;13(1):25-30. (In Russ.) https://doi.org/10.20996/1819-6446-2017-13-1-25-30

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