Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2005 Apr;10(2):179-87.
doi: 10.1111/j.1542-474X.2005.05624.x.

Accelerated idioventricular rhythm in the post-thrombolytic era: incidence, prognostic implications, and modulating mechanisms after direct percutaneous coronary intervention

Hendrik Bonnemeier  1 , Jasmin Ortak, Uwe K H Wiegand, Frank Eberhardt, Frank Bode, Heribert Schunkert, Hugo A Katus, Gert Richardt
Affiliations

Accelerated idioventricular rhythm in the post-thrombolytic era: incidence, prognostic implications, and modulating mechanisms after direct percutaneous coronary intervention

Hendrik Bonnemeier et al. Ann Noninvasive Electrocardiol. 2005 Apr.

Abstract

Background: In the thrombolytic era, the occurrence of accelerated idioventricular rhythm (AIR) has been proposed to be a specific marker for successful reperfusion. The incidence, prognostic implications, and potential modulating mechanisms of AIR after successful restoration of antegrade flow by means of modern reperfusion therapy (i.e., direct percutaneous coronary intervention (PCI)) has thus far not been investigated.

Methods: We prospectively investigated 125 consecutive patients undergoing direct PCI for a first acute myocardial infarction (AMI). The incidence of AIR was determined from 24-hour Holter monitoring, initiated prior to PCI.

Results: AIR appeared in 19 patients (15.2%). There were no significant differences between patients with or without AIR regarding baseline clinical characteristics. The incidence of AIR was not different between patients with TIMI 2 and 3 flow (13% vs 16%). There were no differences in the incidence of major cardiac events within 12-month follow-up in patients with and without AIR. Patients with AIR exhibited higher mean R-R intervals (mean 24-hour R-R interval: 871.3 +/- 121 vs 796.4 +/- 100 ms, P < 0.01), higher hourly mean values of heart rate variability (SDNN, 64.7 +/- 26 vs 49.4 +/- 20 ms, P < 0.01; rMSSD, 29.3 +/- 15 vs 22.0 +/- 12 ms, P < 0.01) and lower serum norepinephrine concentrations (60 minute after PCI, 478.9 +/- 357 vs 649.0 +/- 499 pg/ml, P < 0.05).

Conclusions: Our findings indicate that AIR is an nonspecific marker for reperfusion of the infarct-related artery in AMI and thus, predate previous observations of the thrombolytic era. Even though, AIR was associated with higher tonic vagal tone and lower sympathetic activity, the occurrence of AIR had no prognostic impact on the clinical course and was not able to discriminate between complete and incomplete reperfusion.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Holter ECG printout showing an example of AIR onset with a long coupling interval. (B) ECG printout showing examples of fusion (f) and capture (c) beats in AIR. (C) ECG printout showing an example of isorhythmic dissociation (P waves are marked with arrows).
Figure 2
Figure 2
Kaplan–Meier survival curve representing cumulative event‐free plot for major cardiac events for patients with and without AIR after direct PCI (P = 0.66).
Figure 3
Figure 3
Initial appearance of AIR after successful PCI for AMI.
Figure 5
Figure 5
Hourly mean R‐R interval in patients with and without AIR after direct PCI.
Figure 4
Figure 4
Division of patients according to TIMI flow after direct PCI and the presence of AIR.
Figure 6
Figure 6
Time domain heart rate variability in patients with (black bars) and without AIR (white bars) after direct PCI. *P < 0.05, **P < 0.01.
Figure 7
Figure 7
Arterial plasma norepinephrine concentrations in patients with and without AIR after direct PCI.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Marriott JCJL, Menendez MM. A‐V dissociation revisited. Prog Cardiovasc Dis 1966;8: 522–538. - PubMed
    1. Grimm W, Hoffmann J, Maisch B. Akzelerierter idioventrikulärer rhythmus. Z Kardiol 1994;83: 898–907. - PubMed
    1. Goldberg S, Greenspon AJ, Urban PL, et al Reperfusion arrhythmias: A marker of restoration of antegrade flow during intracoronary thrombolysis for acute myocardial infarction. Am Heart J 1983;105: 26–31.DOI: 10.1016/0002-8703(83)90274-0 - DOI - PubMed
    1. Gressin V, Louvard Y, Pezzano M, et al Holter recording of ventricular arrhythmias during intravenous thrombolysis for acute myocardial infarction. Am J Cardiol 1992;69: 152–159.DOI: 10.1016/0002-9149(92)91295-F - DOI - PubMed
    1. Gorgels APM, Vos MA, Letsch IS, et al Usefulness of the accelerated idioventricular rhythm as a marker for myocardial necrosis and reperfusion during thrombolytic therapy in acute myocardial infarction. Am J Cardiol 1988;61: 231–235.DOI: 10.1016/0002-9149(88)90921-6 - DOI - PubMed

Publication types