title: Reperfusion ventricular arrhythmia 'bursts' in TIMI 3 flow restoration with primary angioplasty for anterior ST-elevation myocardial infarction: a more precise definition of reperfusion arrhythmias.
abstract: OBJECTIVE
  We sought to define reperfusion-induced ventricular arrhythmias (VAs) more precisely through simultaneous angiography, continuous ST-segment recovery, and beat-to-beat Holter analyses in subjects with anterior ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty [percutaneous coronary intervention (PCI)].
  
  
  RESULTS
  All 157 subjects with final TIMI 3 flow had continuous 12-lead electrocardiography with simultaneous Holter recording initiated prior to PCI for continuous ST-segment recovery and quantitative VA analyses. Ventricular arrhythmia bursts were detected against subject-specific background VA rates using a statistical outlier method. For temporal correlations, timing and quality of reperfusion were defined as first angiographic TIMI 3 flow with >or=50% stable ST-segment recovery. Almost all subjects had VAs [156/157 (99%)], whereas VA bursts during or subsequent to reperfusion occurred in 97/157 (62%). The majority of VA bursts (72%) arose within 20 min of reperfusion (95% CI: 26.7, 72), with onset at a median of 4 min post-reperfusion (IQR: 0-43) Bursts comprised a median of 1290 ventricular premature complexes (VPCs) (IQR: 415-4632) and persisted for a median of 105 min (IQR: 35-250). Most background VAs occurred as single VPCs; bursts typically comprised runs of three or more VPCs. Subjects with bursts had higher absolute peak ST segments and more frequent worsening of ST elevation immediately after reperfusion.
  
  
  CONCLUSIONS
  Ventricular arrhythmia bursts temporally associated with TIMI 3 flow restoration and stable ST-segment recovery (reperfusion VA bursts) can be precisely defined in subjects with anterior STEMI and may constitute a unique electric biosignal of myocellular response to reperfusion.
authors.affiliation: Duke Clinical Research Institute, 508 Fulton Street, Room A3012, Durham, NC 27705, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Majidi
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.forename: Miguel E
authors.initials: ME
authors.lastname: Lemmert
authors.forename: Lilian
authors.initials: L
authors.lastname: Smolders
authors.forename: Anton
authors.initials: A
authors.lastname: van Weert
authors.forename: Johan H C
authors.initials: JH
authors.lastname: Reiber
authors.forename: Dan
authors.initials: D
authors.lastname: Tzivoni
authors.forename: Frits W H M
authors.initials: FW
authors.lastname: Bär
authors.forename: Hein J J
authors.initials: HJ
authors.lastname: Wellens
authors.forename: Anton P M
authors.initials: AP
authors.lastname: Gorgels
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000601:surgery*; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis* / Q000601:surgery*; D017180:Tachycardia, Ventricular / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D009626:Terminology as Topic