Skip to main content
SpringerLink
Log in

Usefulness of the accelerated idioventricular rhythm as a marker for myocardial necrosis and reperfusion during thrombolytic therapy in acute myocardial infarction

  • Chapter
Professor Hein J.J. Wellens

Abstract

The value of the accelerated idioventricular rhythm (AIVR) as a marker for myocardial necrosis and/or reperfusion was prospectively studied in 87 patients admitted with persistent ischemic chest pain. All patients received streptokinase. Necrosis was diagnosed by new Q waves and an increase in plasma enzymes. Reperfusion was documented angiographically. Myocardial necrosis occurred in 72 patients and reperfusion in 70 patients, 58 of whom had myocardial necrosis. Of 27 patients with AIVR, 26 had both necrosis and reperfusion (p < 0.001).

AIVR started after a long coupling interval to the preceding sinus rhythm and was regular. Configuration depended on the reperfused infarct vessel. Reperfusion of the left anterior descending branch showed most configurations of AIVR and with the least QRS width. Reperfusion of the circumflex branch never had a left bundle branch block-like configuration. AIVR from reperfusion of the right coronary artery never had an inferior axis. AIVR occurring during persistent ischemic chest pain is a marker for both myocardial necrosis and reperfusion of the infarct vessel. AIVR starts with a long coupling interval and is regular. The QRS configuration may be useful for the noninvasive identification of the infarct vessel.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 289.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Myerburg RS, Conde CA, Sung RJ, Mallon SM, Sheps DS, Appel R, Castelanos A: Prehospital cardiac arrest: early and long term clinical electrophysiologic characteristics. In Kulbertus HE, Wellens HJJ (eds.). Sudden Death. Developments in Cardiovascular Medicine 4. Martinus Nijhoff, The Hague, pp. 219–231, 1980.

    Google Scholar 

  2. Marriott JCJL, Menendez MM: A-V dissociation revisited. Prog Cardiovasc Dis 8: 522–538, 1966.

    Article  PubMed  CAS  Google Scholar 

  3. Rothfeld EL, Zucker JR, Parsonnet V, Alinsonorin CA: Idioventricular rhythm in acute myocardial infarction. Circulation 27: 203–209, 1968.

    Article  Google Scholar 

  4. Schamroth L: Idioventricular tachycardia. J. Electrocardiol 1: 205–212, 1968.

    Article  PubMed  CAS  Google Scholar 

  5. Castellanos A Jr, Lemberg L, Arcebal AG: Mechanisms of slow ventricular tachycardias in acute myocardial infarction. Dis Chest 56: 470–476, 1969.

    Article  PubMed  Google Scholar 

  6. Massumi RA, Ali N: Accelerated isorhythmic ventricular rhythms. Am J Cardiol 26: 170–185, 1970.

    Article  PubMed  CAS  Google Scholar 

  7. Norris RM, Mercer CJ, Yeates SE: Idioventricular rhythm complicating acute myocardial infarction. Br Heart J 32: 617–621, 1970.

    Article  PubMed  CAS  Google Scholar 

  8. Gallagher JL, Damato AN, Lau SH: Electrophysiological studies during accelerated idoventricular rhythms. Circulation 44: 671–677, 1971.

    Article  PubMed  CAS  Google Scholar 

  9. Zipes DP, Fisch C: Accelerated ventricular rhythm. Arch Intern Med 129: 651–652, 1972.

    Google Scholar 

  10. Norris RM, Mercer CJ: Significance of idioventricular rhythms in acute myocardial infarction. Prog Cardiovasc Dis 16: 455–467, 1974.

    Article  PubMed  CAS  Google Scholar 

  11. de Soyza N, Bisset JK, Kane JJ, Murphy ML, Doherty JE: As-sociation of accelerated idioventricular rhythm and paroxysmal ventricular tachycardia in acute myocardial infarction. Am J Cardiol 34: 667–670, 1974.

    Article  PubMed  Google Scholar 

  12. Basu D, Scheinman M: Sustained accelerated idioventricular rhythm. Am Heart J 89: 227–231, 1975.

    Article  PubMed  CAS  Google Scholar 

  13. Lichstein E, Ribas-Meneclier C, Gupta PK, Chadda KD: Incidence and description of accelerated ventricular rhythm complicating acute myocardial infarction. Am J Med 58: 193–198, 1975.

    Article  Google Scholar 

  14. Talbot S, Greaves M: Association of ventricular extrasystoles and ventricular tachycardia with idioventricular rhythm. Br Heart J 38: 457–464, 1975.

    Article  Google Scholar 

  15. Bigger JT Jr, Dresdale RJ, Heissenbuttel RH, Weld FM, Wit AL: Ventricular arrhythmias in ischemic heart disease: mechanism, prevalence, significance and management. Prog Cardiovasc Dis 19: 255–300, 1977.

    Article  PubMed  Google Scholar 

  16. Goldberg S, Greenspan AJ, Urban PL, Muza B, Berger B, Walinsky P, Maroko PR: Reperfusion arrhythmia: a marker of restoration of anterograde flow during intracoronary thrombolysis for acute myocardial infarction. Am Heart J 105: 26–32, 1983.

    Article  PubMed  CAS  Google Scholar 

  17. Sclarovsky S, Strasberg B, Fuchs J, Lewin RF, Arditi A, Klainman E, Kracoff OH, Agmon J: Multiform accelerated idioventricular rhythm in acute myocardial infarction: electrocardiographic characteristics and response to verapamil. Am J Cardiol 52: 43–47, 1983.

    Article  PubMed  CAS  Google Scholar 

  18. Buckingham TA, Devine JE, Redd RM, Kennedy HL: Reperfusion arrhythmias during coronary reperfusion in man. Chest 90: 346–351, 1986.

    Article  PubMed  CAS  Google Scholar 

  19. Sclarovsky S, Strasberg B, Martonovich G, Agmon J: Ventricular rhythms with intermediate rates in acute myocardial infarction. Chest 74: 180–182, 1978.

    Article  PubMed  CAS  Google Scholar 

  20. Wellens HJJ: The electrocardiogram in digitalis intoxication. In Yu PN, Goodwin JF (eds.). Progress in Cardiology 5. Lea and Febiger, Philadelphia, pp. 271–290, 1976.

    Google Scholar 

  21. Rentrop KP, Blanke H, Karsch KR: Effects of nonsurgical coronary reperfusion in the left ventricle in human subjects compared with conventional treatment. Am J Cardiol 49: 1–7, 1982.

    Article  PubMed  CAS  Google Scholar 

  22. Simoons ML, Serruys PW, vd Brand M, de Zwaan C, Bär FW, Res J, Verheugt FWA, Krauss XH, Remme WJ, Vermeer F, Lubsen J: Improved survival after early thrombolysis in acute myocardial infarction. Lancet 2: 578–582, 1985.

    Article  PubMed  CAS  Google Scholar 

  23. Simoons ML, Serruys PW, vd Brand M, Res J, Verheugt FW, Krauss XH, Remme WJ, Bär FW, de Zwaan C, van der Laarse A, Vermeer F, Lubsen J: Thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival. JACC 7: 717–728, 1987.

    Article  Google Scholar 

  24. Schamroth L: Genesis and evolution of ectopic ventricular rhythm. Br Heart J 28: 244–248, 1966.

    Article  PubMed  CAS  Google Scholar 

  25. Rosen MR, Fisch C, Hoffmann BF, Danilo P, Lovelace DF, Knoebel SB: Can accelerated atrioventricular junctional escape rhythms be explained by delayed after-depolarizations? Am J Cardiol 45: 1272–1284, 1980.

    Article  PubMed  CAS  Google Scholar 

  26. Ferrier GR, Moffat MP, Lukas A: Possible mechanisms of ventricular arrhythmias elicited by ischemia followed by reperfusion. Circ Res 56: 184–194, 1985.

    Article  PubMed  CAS  Google Scholar 

  27. Eisner DA, Lederer WJ: A cellular basis for licocaine’s antiarrhythmic action. J Physiol 295: 25–26, 1979.

    Google Scholar 

References

  1. Gorgels APM, Vos MA, Letsch IS, Verschuuren EA, Bär FWHM, Janssen JHA, Wellens HJJ: Usefulness of the accelerated idioventricular rhythm as a marker for myocardial necrosis and reperfusion during thrombolytic therapy in acute myocardial infarction. Am J Cardiol 61: 231–235, 1988.

    Article  PubMed  CAS  Google Scholar 

  2. Wellens HJJ, Bär FWH, Lie KI: The value of the electrocar-diogram in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Cardiol 64: 27–33, 1978.

    CAS  Google Scholar 

  3. Farré J, Wellens HJJ: The value of the electrocardiogram in diagnosing site of origin and mechanism of supraventricular tachycardia. In Wellens HJJ, Kulbertus H (eds.). What is new in electrocardiography. Martinus Nijhoff, The Hague, Vol. 9, pp. 131–171, 1981.

    Chapter  Google Scholar 

  4. Braat SHJG, Gorgels APM, Bär FWHM, Wellens HJJ: Value of the ST-T segment in lead V4R inferior wall acute myocardial infarction to predict the site of coronary arterial occlusion. Am J Cardiol 62: 140–143, 1988.

    Article  PubMed  CAS  Google Scholar 

  5. de Zwaan C, Bär FW, Janssen JH, Cheriex EC, Dassen WR, Brugada P, Penn OC, Wellens HJ: Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Am Heart J 117: 657–665, 1989.

    Article  PubMed  Google Scholar 

  6. Gorgels APM, Vos MA, Mulleneers R, de Zwaan C, Bär FWHM, Wellens HJJ: Value of the electro-cardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectoris. Am J Cardiol 72: 999–1003, 1993.

    Article  PubMed  CAS  Google Scholar 

  7. Engelen DJ, Gorgels AP, Cheriex EC, De Muinck ED, Oude Ophuis AJ, Dassen WR, Vainer J, Van Ommen VG, Wellens HJ: Value of the electrocardiogram in localizing the occlusion site in the left coronary artery in acute anterior myocardial infarction. J Amer Coll Cardiol 34: 389–395, 1999.

    Article  CAS  Google Scholar 

  8. Doevendans PA, Gorgels APM, van der Zee R, Partouns J, Bär FWHM, Wellens HJJ: Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am J Cardiol 75: 1206–1210, 1995.

    Article  PubMed  CAS  Google Scholar 

  9. Oude Ophuis TJ, Bär FW, Vermeer F, Krijne R, Jansen W, de Swart H, van Ommen V, de Zwaan C, Engelen D, Dassen WR, Wellens HJJ: Early referral for intentional rescue PTCA after initiation of thrombolytic therapy in patients admitted to a community hospital because of a large myocardial infarction. Am Heart J 137: 847–853, 1999.

    Article  Google Scholar 

  10. Gressin V, Gorgels APM, Louvard Y, Lardoux H, Bigelow R: ST-segment normalization time and ventricular arrhythmias as electrocardiographic markers of reperfusion during intravenous thrombolysis for acute myocardial infarction. Am J Cardiol 71: 1436–1439, 1992.

    Article  Google Scholar 

  11. Gression V, Louvard Y, Gorgels APM, Pezzano M, Lardoux H: Arythmies de reperfusion. Arch Mal Coeur Vaiss 86:4: 69–77, 1993.

    Google Scholar 

  12. Gorgels APM, Beekman HDM, Brugada P, Dassen WRM, Richards DAB, Wellens HJJ: Extrastimulus related shortening of the first postpacing interval in digitalis induced ventricular tachycardia. Observations during programmed electrical stimulation in the conscious dog. J Am Coll Cardiol 1: 840–857, 1983.

    Article  PubMed  CAS  Google Scholar 

  13. Vos MA, Gorgels APM, Leunissen HDM, Havenith MG, Kriek E, Smeets JLRM, Wellens HJJ: Programmed electrical stimulation and drugs identify two subgroups of ventricular tachycardias occurring 16-24 h after occlusion of the left anterior descending artery. Circulation 85: 747–755, 1992.

    Article  PubMed  CAS  Google Scholar 

  14. Vos MA, Verduyn SC, Gorgels APM, Lipcsei GC, Wellens HJJ: Reproducible induction of early afterdepolarizations and Torsade de Pointes arrhythmias by d-sotalol and pacing in dogs with chronic AV-block. Circulation 91: 864–872, 1995.

    Article  PubMed  CAS  Google Scholar 

  15. Volders PGA, Sipido KR, Vos MA, Kulczar A, Verduyn SC, Wellens HJJ: Cellular basis of biventricular hypertrophy and arrhythmogenesis in dogs with chronic complete atrioventric-ular block and acquired torsade de pointes. Circulation 98: 1136–1147, 1998.

    Article  PubMed  CAS  Google Scholar 

  16. Gorgels APM, Vos MA, Brugada P, Wellens HJJ: The clinical relevance of abnormal automaticity and triggered activity. In Brugada P, Wellens HJJ (eds.). Cardiac arrhythmias: Where to go from here? Futura Publishing Company, Mount Kisco, NY, Vol. 8, pp. 147–169, 1987.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands

    Anton P. M. Gorgels, Marc A. Vos, Ingrid S. Letsch, Erik A. Verschuuren, Frits W. H. M. Bär, Johan H. A. Janssen & Hein J. J. Wellens

Authors
  1. Anton P. M. Gorgels
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc A. Vos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ingrid S. Letsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erik A. Verschuuren
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frits W. H. M. Bär
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johan H. A. Janssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hein J. J. Wellens
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

J. L. R. M. Smeets P. A. Doevendans M. E. Josephson Ch. Kirchhof M. A. Vos

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Gorgels, A.P.M. et al. (2000). Usefulness of the accelerated idioventricular rhythm as a marker for myocardial necrosis and reperfusion during thrombolytic therapy in acute myocardial infarction. In: Smeets, J.L.R.M., Doevendans, P.A., Josephson, M.E., Kirchhof, C., Vos, M.A. (eds) Professor Hein J.J. Wellens. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4110-9_39

Download citation

  • DOI: https://doi.org/10.1007/978-94-011-4110-9_39

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-5799-8

  • Online ISBN: 978-94-011-4110-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation