| The incidence of Acute myocardial infarction (AMI) is acute,the condition and complication of AMI is severe,and the mortality rate of AMI is high.Studies show that the infarct related artery (IRA) that is opened early, full and lasting can reduce infarct size and protect cardiac function,not only the recurrence and mortality rate of AMI is reduced, but the prognosis of patients and quality of life can be improved,especially in high-risk patients (such as cardiogenic shock, heart failure, anterior wall myocardial infarction). Compared with thrombolytic therapy, percutaneous coronary intervention (PCI) can increase the recanalization rate of infarct-related artery significantly. However,there are a variety of severe reperfusion arrhythmias (RA) in primary percutaneous coronary intervention. such as, short-term accelerated idioventricular rhythm, burst ventricular tachycardia (VT) or ventricular fibrillation (VF ), atrioventricular or bundle branch block disappeared suddenly, transient sinus bradycardia, sinoatrial block, etc. As one of the important indicators of Coronary recanalization,its incidence is 50% to 80%. At present, we have found that accelerated idioventricular rhythm is common, and transient sinus bradycardia can be used as a reliable indicator of reperfusion for inferior myocardial infarction. These arrhythmias often result in hemodynamic changes, especially ventricular arrhythmias. it is one of the reasons of sudden death for patients in ischemia-reperfusion period.If it can not be dealt timely,it will lead to serious consequences.If it is given the right prevention and treatment,it can reduce the reperfusion injury.Accordingly,the survival rate of patients with AMI can be increased and the prognosis can be improved.At present,the mechanism of Reperfusion arrhythmia is considered that there are several aspects as follows:calcium overload, increased of oxygen free radicals, Neutrophil activation and microvascular injury , increased of self-discipline by increased of catecholamine, decreased of ischemic ventricular fibrillation threshold after reperfusion and Refractory period that be shorten should be easy to occur reentrant mechanism. In addition, the flow rate of reperfusion,the size of blocked vascular bed, Collateral blood flow and the arrhythmias before ischemia reperfusion can influence the occurrence of RA. RA also depends on a number of other factors in PCI, including physical and mental state of patients, anatomical characteristics of coronary artery, the quality of contrast agent, equipment selection,the clinical status of patients and so on.For the general RA, such as ventricular premature, transient ventricular tachycardia and accelerated idioventricular rhythm, most of them can disappear without drug therapy, but needing to strengthen monitoring and close observation.In the literature, it has been reported that the preventive effect of lidocaine is invalid in the RA. In the preoperative PCI,dipyridamole injection could raise the level of cyclic adenosine monophosphate,reduce intracellular calcium overload and the occurrence of ventricular arrhythmias. As a result of ventricular arrhythmia,lidocaine or amiodarone needs to be preferred. For the bradyarrhythmia, if the ventricular rate is less than 45 times/min,we can inject 0.5 ~ 1.0mg atropine and observe the heart rate, prepare temporary cardiac pacemaker;if the patients need isoproterenol,we should use Infusion Pump to control the speed,and make the heart rate maintained at 50 ~ 70 times/min, preventing isoproterenol bundle from pacing rhythm and inducing ventricular arrhythmia and tachyarrhythmia. Defibrillator should be placed near the bed, adjusting the discharge energy and painting the conductive adhesive.If the ventricular fibrillation appears suddenly during the PCI,we should select Non-synchronous electric defibrillator immediately.If the patients occur the reperfusion arrhythmias during the PCI,we should observe condition more than 30min in the catheter room,and then escorting the patients to the ward.Clinical and animal experimental study has found that the use of free radical scavenger can reduce the generation of free radicals and the infarct size,preventing the occurrence of reperfusion arrhythmias before reperfusion, such as Superoxide dismutase (SOD), catalase (CAT), Glutathione, VitC, Coenzyme Q and so on. It has been reported that Ca2+antagonist, a-blocker,β-blockers, magnesium sulfate, ACEI, angiotensinâ… receptor antagonists (ARBs), H1 receptor blocker, vitE, ATP or FDP can reduce or prevent the occurrence of reperfusion arrhythmias also.However,the clinical prevention of reperfusion arrhythmia remains to be in-depth study.In short, reperfusion arrhythmias is an important indicators for coronary recanalization.But it can cause harm to patients, or even death. If it is given the right prevention and treatment,it can reduce the reperfusion injury. Accordingly,the survival rate of patients with AMI can be increased and the prognosis can be improved.Objective:During the primary percutaneous coronary intervention,the patients with Acute myocardial infarction (AMI) may emerge reperfusion arrhythmia.Investigating the clinical characteristics and treatment of reperfusion arrhythmia,in order to improve the success rate. Accordingly,the survival rate of patients with AMI can be increased and the prognosis can be improved.Methods: Collecting the Clinical datas from March 2007 to March 2009 in the Cardiology Department of Jilin University China-Japan union Hospital,those Clinical datas must be from acute myocardial infarction patients with emergency coronary angiography prompted infarct-related artery blood flow TIMI0～1 level,and then going on percutaneous coronary intervention (PCI ). Total 100 cases.And 56 cases of them occurred reperfusion arrhythmia, observing the type of reperfusion arrhythmia, the relationship between reperfusion arrhythmia and the time of incidence to coronary artery recanalization , the relationship between reperfusion arrhythmia and infarction, the relationship between reperfusion arrhythmia and infarct size. All datas analysis used statistical software SPSS13.0. Measurement data (in this study are in line with the normal distribution) with the mean addition and subtraction in mean difference. using t tests, count data usingχ~2 test.Results:1.The reperfusion arrhythmia incidence of the patients with AMI operated PPCI within 6h is significantly higher than the patients with AMI operated PPCI between 6h and 12h(77.8%vs30.4%P<0.01).2.Compared with inferior and (or) Posterior wall myocardial infa- rction,the patients with anterior wall myocardia infarction mainly appear rapid reperfusion arrhythmia (40.9%vs3.7%P<0.05). Compared with anterior wall myocardia infarction, the patients with inferior and (or) Posterior wall myocardial infarction mainly appear Slow reperfusion arrhythmia (61.1%vs6.8%P<0.01).3.The incidence of reperfusion arrhythmias is no significant difference between the patients with limited myocardial infarction and the patients with extensive anterior wall myocardial infarction(54.5%vs51.9%P= 0.835).Conclusion:1.The reperfusion arrhythmias of the patients with AMI is a relatively common complication in primary percutaneous coronary intervention.2.Reperfusion arrhythmia and the time of incidence to coronary artery recanalization have a certain relationship.Short ischemia, myocardial injury was not obvious; ischemia time is too long, myocardial Cells lose of electrical activity. Both of them are not easy to appear ischemia reperfusion arrhythmia.3.Compared with anterior wall myocardia infarction, the patients with inferior and (or) Posterior wall myocardial infarction mainly appear Slow reperfusion arrhythmia.4.The incidence of reperfusion arrhythmias is no significant difference between the patients with limited myocardial infarction and the patients with extensive anterior wall myocardial infarction.5. Reperfusion arrhythmias are mostly benign in primary percutaneous coronary intervention,most of them can disappear without drug therapy.
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