Ventricular fibrillation following administration of thrombolytic treatment: The EMIP experience

Reperfusion-induced ventricular fibrillation has been dem onstratedin animal models of myocardial ischaemia, but no evidence existsfor this in humans. The European Myocar dial Infarction Projectcompared the efficacy and safety of pre-hospital thrombolytictherapy with that of hospital therapy. The objective of thisstudy was to investigate the occurrence of reperfusion-inducedventricular fibrilla tion in acute myocardial infarction patientsfollowing thrombolytic therapy. In a double-blind multicentre trial, eligible patients wererandomized to receive anistreplase at home followed by placeboin the hospital (A/P group), or placebo followed by anistreplase(P/A group). The occurrence of ventricular fibrillation, andother adverse events were recorded on specific study forms andcould be attributed to defined time intervals. The incidence of ventricular fibrillation in the A/P group wassignificantly higher following the pre-hospital injection thanin the P/A group (2.5% vs 1.6%; P=0.021); the situation wasreversed following the hospital injection (3.6% vs 5.3%; P=0.002).No relationship was found be tween this excess of ventricularfibrillation and the patients condition, with the exceptionof the site of the infarct. These results suggest the existence of reperfusion-induced ventricularfibrillation in patients developing myocardial infarction whoreceive thrombolytic treatment.