title: Acute haemodynamic effects of accelerated idioventricular rhythm in primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Accelerated idioventricular rhythm (AIVR) is very frequently observed in primary percutaneous coronary intervention (PCI), however knowledge of the haemodynamic effects is lacking.
  
  
  RESULTS
  We studied an ST-segment elevation myocardial infarction cohort of 128 consecutive patients (aged 62±11 years) in whom AIVR occurred following reperfusion during primary PCI. Mean systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were determined during periods of AIVR and sinus rhythm. We grouped patients according to the infarct-related artery and the site of the coronary occlusion. AIVR caused an immediate reduction in SBP (130±27 vs. 98±22 mmHg, p<0.001) and DBP (80±19 vs. 69±16 mmHg, p<0.001) and a small increase in heart rate (78±12 vs. 83±11 bpm, p<0.001) as compared to sinus rhythm, irrespective of infarct-related artery. Both absolute as well as relative reduction in SBP were more pronounced in distal than proximal left coronary artery (LCA) occlusions (36±16 vs. 27±12 mmHg, p<0.01, respectively 25±9 vs. 20±8%, p<0.05). These haemodynamic differences between proximal and distal occlusion sites were not observed in the right coronary artery.
  
  
  CONCLUSIONS
  AIVR following reperfusion is associated with marked reduction in both SBP and DBP, irrespective of infarct-related artery. These haemodynamic effects are accompanied by only a very modest increase in heart rate during AIVR. Patients with a culprit lesion in the proximal LCA showed a smaller reduction in systolic blood pressure than distal LCA lesions.
authors.affiliation: Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ronak
authors.initials: R
authors.lastname: Delewi
authors.forename: Maurice
authors.initials: M
authors.lastname: Remmelink
authors.forename: Martijn
authors.initials: M
authors.lastname: Meuwissen
authors.forename: Niels
authors.initials: N
authors.lastname: van Royen
authors.forename: Marije M
authors.initials: MM
authors.lastname: Vis
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Jan
authors.initials: J
authors.lastname: Baan
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
mesh_terms: D016170:Accelerated Idioventricular Rhythm / Q000209:etiology / Q000503:physiopathology*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001794:Blood Pressure; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009426:Netherlands; D013997:Time Factors; D016896:Treatment Outcome