The Affection Of Atropine Pretreatment On The Reperfusion Arrhythmias Before The Acute Inferior Myocardial Infarction Coronary Artery Recanalization

The affection of atropine pretreatment on the reperfusion arrhythmias before the acute inferior myocardial infarction coronary artery recanalizationPrefaceAcute myocardial infarction (AMI) is defined as death or necrosis of myocardial cells. Critical myocardial ischemia may occur as a result of increased myocardial metabolic demand and/or decreased delivery of oxygen and nutrients to the myocardium via the coronary circulation. An interruption in the supply of myocardial oxygen and nutrients occurs when a thrombus is superimposed on an ulcerated or unstable atherosclerotic plaque and results in coronary occlusion. Reperfusion arrhythmia (RA) is induced in the periods of coronary artery occlusion followed by release of the occlusion that allowed reperfusion. Emergency often treat with all kinds of serious reperfusion arrhythmia (RA) patients. Without timely treatment, patients can lead to serious consequences. In this view we investigate the incidence of the acute myocardial infarction reperfusion treatment (emergency PCI) caused reperfusion arrhythmia and provide the basis for the reperfusion arrhythmia clinical prevention and treatment. Preoperative atropine treatment was applied on the acute inferior myocardial infarction (emergency PCI) patients to analyze the clinical nursing significance of the atropine treatment on reperfusion arrhythmia (SB,SA and high AVB). Materials and methods252 AMI patients were randomly selected in the first subsidiary of China Medical University College and Shen Zhou hospital subsidiary of Shenyang Medical Collegewere during the period from January 2005 to May 2006. The AMI patients treated by PCI within 12 hours were divided into acute myocardial infarction group and acute inferior myocardial infarction group. 92 AMI patients were randomly selected in the two hospitals during the period from June 2006 to May 2007. According to the principle of matching patients were divided into two groups. The experimental group was treated atropine before coronary artery recanalization and the control group without any treatment. A comparison of the incidences of arrhythmias and frequency, the type of arrhythmia in the groups had been performed.ResultTotal 252 cases met the standard, 135 patients were in acute myocardial infarction group, and 69 cases (51.1%) were RA, 71 cases were ventricular arrhythmias (VA), 13 cases were slow arrhythmia (SA) in the group. 117 patients were in acute inferior myocardial infarction group and 73 cases (62.4%) were RA, 34 cases were ventricular arrhythmias (VA), 83 cases were slow arrhythmia(SA) in the group. The incidence of ventricular arrhythmias between acute myocardial infarction and acute inferior myocardial infarction were the significance statistic difference. And the incidence of slow arrhythmia between acute myocardial infarction and acute inferior myocardial infarction were the significance statistic difference. 46 patients were in acute inferior myocardial infarction experimental group (atropine pretreatment group) and 17 cases (37.0%) were R.A, 12 cases were ventricular arrhythmias (VA), 15 cases were slow arrhythmia (SA) in the group. 28 patients (60.9%) were RA, 9 cases were ventricular arrhythmias (VA) and 33 cases were slow arrhythmia (SA) in the acute inferior myocardial infarction control group without any treatment. The incidence of slow arrhythmia was the significance statistic difference between acute inferior myocardial infarction group with atropine pretreatment group and without atropine pretreatment group.DiscussionAccording the analysis of infarct relative artery, the incidence of infarction, VP were high, followed by ventricular tachycardia and deadly reperfusion arrhythmias (SB, SA and high AVB) was lower and VF was only two time in LAD group. The incidence of deadly reperfusion arrhythmias was high in RCA group and the PVT and VF were obviously higher than LAD groups. Overall, the incidence of LAD accelerated idioventricutar rhythm was high, but deadly reperfusion arrhythmias (SA, high AVB, PVT and VF) was low and normally did not treat with preventive anti-arrhythmic drugs. The incidence of RCA deadly reperfusion arrhythmias and fatal reperfusion arrhythmias were high. Deadly reperfusion arrhythmias due to two reasons. The first reason is that the sinus blood supply is reduced. The second is that under the wall and left ventricular posterior wall of the heart more inhibitory receptors are located, reperfusion induced vagal reflex and impulse imported vasomotor center. Vasomotor center inhibit sympathetic nerve activity and activation of parasympathetic efferent fibers (Bezold-Jarisch reflexion) . High AVB and sinus arrest often require immediate pacing treatment. In order to rapidly implement temporary pacing treatment to chronic cardiac arrhythmia, conventionally we need preset vein sheath before treating acute inferior myocardial infarction patients with PCI. The atropine pretreatment can effectively reduce the incidence of chronic cardiac arrhythmia and reduce pacemaker application times.The incidence of right coronary artery infarction chronic cardiac arrhythmia and the incidence of fatal arrhythmias were high, similar with the reported. High AVB and sinus arrest often require immediate pacing treatment. In order to rapidly implement temporary pacing treatment to chronic cardiac arrhythmia, conventionally we need preset vein sheath before treating acute inferior myocardial infarction patients with PCI. The reoperative atropine treatment can effectively reduce the incidence of chronic cardiac arrhythrnia and reduce temporary pacemaker application.ConclusionThe incidence of ventricular premature (VP) in LAD was significantly higher than RCA patients (P＜0.01) and the incidence of RA in RCA patients was significantly higher than LDA (P＜0.01).The incidence of RA in RCA group with the atropine pretreatment was significantly lower than RCA group without the atropine pretreatment (P＜0.01). The atropine pretreatment can effectively reduce pacemaker application times.