Interactions between Thrombolysis and Sudden Cardiac Death

Abstract

One of the most exciting developments in the treatment of coronary artery disease in recent years has been the development of thrombolytic agents to treat acute myocardial infarction. In early studies, thrombolytic agents such as streptokinase and later PTA were injected directly into the affected coronary artery. Later studies demonstrated that even intravenous administration of thrombolytic agents can be effective in lysing clots within coronary arteries. In early thrombolytic intracoronary studies, ventricular tachyarrhythmias were often observed following reperfusion of the affected coronary vessel. Mathey et al. reported a 17% incidence of ventricular fibrillation in 30 patients with mean time to entry for reperfusion of 83 ± 56 minutes (1). However in the more recent intravenous thrombolytic clinical trials the occurrence of ventricular tachyarrhythmias during reperfusion has not been a significant problem. This is somewhat surprising since in animal studies malignant ventricular tachyarrhythmias are far more often associated with reperfusion than with acute total coronary occlusion.