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Cardiac Arrhythmias pp 131–144Cite as

Late Open Artery Hypothesis and Cardiac Electrical Stability

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Abstract

The concept that late reperfusion resulting in a patent infarct artery causes benefit beyond myocardial salvage (also referred to as the open artery hypothesis) remains somewhat controversial. The seminal animal studies are reviewed in this chapter that lead to two decades of inquiry into the open artery hypothesis. In the rat, Hochman and Choo showed that late reperfusion independent of myocardial infarct size may still improve healing of the infarct, resulting in a thicker infarct wall, less infarct expansion, less LV dilation, and improved cardiac function. Translational evidence for late reperfusion having a benefit on ventricular cavity size during chronic post-infarct healing is reviewed in association with cardiac electrical stability. Consistent with that idea, randomized clinical trials have clearly shown that reperfusion within 6 h reduces mortality and reduces the incidence of induced ventricular tachycardia. Although, the 6-h cutoff for reperfusion in acute MI patients is based primarily on old thrombolytic data. More recent trials with longer time to reperfusion cutoff levels have been performed with percutaneous transluminal coronary angioplasty (PTCA) with or without stents. Notably, the benefits of late reperfusion do not depend on the amount of salvaged myocardium at risk in these clinical studies, and reperfusion as late as 12-h and possibly up to 24-h post-MI exert a beneficial effect on ventricular remodeling. Beyond 24 h, however, the data are less encouraging. The results of more recent clinical trials further diminish the enthusiasm for late reperfusion and do not support the concept that late reperfusion improves cardiac electrical stability. In fact some evidence suggests it may be worse.

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Authors and Affiliations

  1. Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

    Craig Steven McLachlan PhD

  2. Department of Pathology, University of Sydney, Darlington, NSW, 2050, Australia

    Brett Hambly MBBS, PhD, DipAnt

  3. Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia

    Mark McGuire MBBS, PhD, FRACP

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  1. Craig Steven McLachlan PhD
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  2. Brett Hambly MBBS, PhD, DipAnt
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  3. Mark McGuire MBBS, PhD, FRACP
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Correspondence to Craig Steven McLachlan PhD .

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Editors and Affiliations

  1. Department of Cardiology, Center Hospitalier Coutances, Coutances, France

    Ambrose S. Kibos

  2. Department of Internal Medicine Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Bradley P. Knight

  3. Division of Cardiology, McGill University Health Center, Montreal, Québec, Canada

    Vidal Essebag

  4. Department of Cardiology, Miami Children's Hospital, Miami, Florida, USA

    Steven B. Fishberger

  5. School of Biology, Chemistry and Health, Manchester Metropolitan University, Manchester, United Kingdom

    Mark Slevin

  6. “Acad. Vasile Candea” Emergency Clinical Center for Cardiovascular Diseases, “Carol Davila” University of Medicine and Pharmacy, “Titu Maiorescu” University Faculty of Medicine,, Bucharest, Romania

    Ion C. Țintoiu

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McLachlan, C.S., Hambly, B., McGuire, M. (2014). Late Open Artery Hypothesis and Cardiac Electrical Stability. In: Kibos, A., Knight, B., Essebag, V., Fishberger, S., Slevin, M., Țintoiu, I. (eds) Cardiac Arrhythmias. Springer, London. https://doi.org/10.1007/978-1-4471-5316-0_10

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