VENTRICULAR-FIBRILLATION FOLLOWING ADMINISTRATION OF THROMBOLYTIC TREATMENT - THE EMIP EXPERIENCE

Reperfusion-induced ventricular fibrillation has been demonstrated in animal models of myocardial ischaemia, but no evidence exists for this in humans. The European Myocardial Infarction Project compared the ef ficacy and safety of pre-hospital thrombolytic therapy with that of ho spital therapy. The objective of this study was to investigate the occ urrence of reperfusion-induced ventricular fibrillation in acute myoca rdial infarction patients following thrombolytic therapy. In a double- blind multicentre trial, eligible patients were randomized to receive anistreplase at home followed by placebo in the hospital (A/P group), or placebo followed by anistreplase (P/A group). The occurrence of ven tricular fibrillation, and other adverse events were recorded on speci fic study forms and could be attributed to defined time intervals. The incidence of ventricular fibrillation in the A/P group was significan tly higher following the pre-hospital injection than in the P/A group (2.5% vs 1.6%; P = 0.021); the situation was reversed following the ho spital injection (3.6% vs 5.3%; P = 0.002). No relationship was found between this excess of ventricular fibrillation and the patients' cond ition, with the exception of the site of the infarct. These results su ggest the existence of reperfusion-induced ventricular fibrillation in patients developing myocardial infarction who receive thrombolytic tr eatment.