Evolution of Late Potentials During the First 8 Hours of Myocardial Infarction Treated with Thrombolysis

It has been demonstrated that successful thrombolytic therapy is associated with a reduction of late potentials in the signal-averaged electrocardiogram (SAECG) recorded within 48 hours after hospital admission. This study extends these observations, using for the first time a longitudinal design investigating whether ischemia and its potential reversal by thrombolytic therapy are associated with dynamic changes in SAECG recordings obtained continuously for 8 hours after the start of therapy in patients with acute myocardial infarction (MI). SAECGs were obtained from 12 patients (2 women and 10 men; ages 63 ± 13 years) with acute MI. The SAECG (X²+ Y²+ Z²)^1/2 was generated with a high pass filter of 40 Hz, noise ≤ 0.3 μV. Comparing the SAECG recordings during the first and eighth hours, there was a significant decrease in filtered QRS duration (fQRS; 119.5 ± 17.1 vs 106.3 ± 15.3 ms) and duration of the low amplitude signals ≤ 40 μV of the terminal QRS (LAS40; 48.8 ± 18 vs 34.2 ± 14.2 ms), and increase of root mean square voltage of the last 40 ms of the QRS (t-RMS; 14.8 ± 9.3 vs 37.8 ± 34.4 μV) (rank test, P ≤ 0.05). In this patient series, there was a significant improvement of fQRS, t-RMS, and LAS40 during the first 8 hours of acute MI, perhaps indicating reversal of ischemia with thrombolysis. Even during acute MI, these markers of delayed conduction allow investigation of intervention induced changes in myocardial conduction and possibly prediction of the patency of the infarct related artery using signal-averaging techniques.