Frequency of Ventricular Arrhythmias during First 24 hours of Acute Myocardial Infarction in Patient Thrombolysed with Streptokinase

Abstract

Objectives: To asses the frequency of ventricular arrhythmias during first 24 hours complicating first episode of 
Acute Myocardial Infarction in patients thrombolysed with Streptokinase. 
Study Design: Cross-sectional, prospective,  observational & quatitative study.  
Place and Duration of Study:  This study was conducted at Sialkot Medical Complex for six months from March 
2010 to August 2010. 
Patients and Methods: 200 consecutive patients with acute myocardial infarction who received streptokinase were 
assessed for ventricular arrhythmias. Monitoring of the patients for ventricular arrhythmias for 24 hours from the 
time of admission was done. Arrhythmias from the cardiac monitor’s memory noted & documented. Ventricular 
arrhythmias studied were ventricular fibrillation (VF), sustained ventricular tachycardia, accelerated idioventricular 
rhythm, non-sustained ventricular tachycardia & premature ventricular beats > 10 beats per hour. Findings were 
recorded on a specially designed proforma. The data were then entered in the computer for analysis & conclusions 
were drawn. 
Results:  Reperfusion arrhythmias were observed in 20% of the patients (40/200) in first 24 hours after thrombolytic 
therapy presenting with  first acute myocardial infarction. All the patients included in the study showed the ECG 
criteria of STEMI and positive quantitatively Troponin T test. Inferior Wall MI was the most common type of acute 
MI. All the patients received IV streptokinase as thrombolytic agent. The patients with Sustained VT (33%) received 
cardioversion & IV amiodarone. Non-sustained VT were managed by  observation only (77%). A total of 35 patients 
survived in first 24 hours, five died. 
Conclusions: Reperfusing arrhythmias are commonly observed in first 24 hours after streptokinase therapy for acute 
myocardial infarctions. Most of the non-sustained reperfusion arrhythmias are left untreated and requires 
observation only but sustained ventricular arrhythmias (VF, VT) can be life-threatening and therefore must be 
considered for treatment. Electrical cardioversion is preferred over pharmacological treatment in case of sustained 
ventricular arrhythmias. Survival can be maximized if these arrhythmias are recognized and managed efficiently.