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(Circulation. 2000;101:624.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Antiarrhythmic Efficacy of Dipyridamole in Treatment of Reperfusion Arrhythmias

Evidence for cAMP-Mediated Triggered Activity as a Mechanism Responsible for Reperfusion Arrhythmias

Presented in part at the 71st Scientific Sessions of the American Heart Association, Dallas, Tex, November 8–11, 1998, and published in abstract form (Circulation. 1998;98[suppl I];I-166.).

Yukihiko Yoshida, MD; Makoto Hirai, MD; Takumi Yamada, MD; Yukiomi Tsuji, MD; Takahisa Kondo, MD; Yasuya Inden, MD; Makoto Akahoshi, MD; Yoshimasa Murakami, MD; Makoto Tsuda, MD; Naoya Tsuboi, MD; Haruo Hirayama, MD; Mitsuhiro Okamoto, MD; Teruo Ito, MD; Hidehiko Saito, MD; Junji Toyama, MD

From the Division of Cardiology (Y.Y., M.H., T.K., Y.I., M.A., H.S.), First Department of Internal Medicine, University of Nagoya School of Medicine, Nagoya; Cardiovascular Center (T.Y., Y.M., M.T., M.O., J.T.), Aichi Prefectural Owari Hospital, Ichinomiya; and the Cardiovascular Center (Y.T., N.T., H.H., T.I.), Nagoya Dai-ni Red Cross Hospital, Nagoya, Japan.

Correspondence to Yukihiko Yoshida, MD, Division of Cardiology, First Department of Internal Medicine, University of Nagoya School of Medicine, 65 Tsurumai, Showa-ku, Nagoya 466-8550, Japan. E-mail ykyoshi{at}wb3.so-net.ne.jp

Background—Intracellular calcium overload is believed to play an important role in development of reperfusion arrhythmias. Dipyridamole, an inhibitor of cellular uptake of adenosine, may prevent or terminate reperfusion arrhythmias by reducing intracellular calcium overload.

Methods and Results—First, we tested for a preventive effect of dipyridamole. Sixty-one patients who underwent primary PTCA for treatment of acute anterior wall myocardial infarction were enrolled in this prospective study. Patients were divided into dipyridamole (DP) and nondipyridamole (non-DP) groups. The 2 groups had similar baseline characteristics. In the DP group, dipyridamole 0.5 mg/kg was infused intravenously for 3 minutes immediately before reperfusion during primary PTCA. Arrhythmias after reperfusion were analyzed from continuous ECG recordings. None of the patients in the DP group (n=23) had accelerated idioventricular rhythms (AIVR) or ventricular tachycardia (VT). In contrast, 7 (18.4%) had AIVR and 3 (7.9%) had VT in the non-DP group (n=38; P<0.01). Second, we tested for a termination effect of dipyridamole. Dipyridamole 0.5 mg/kg was infused intravenously while continuous ECG recordings were obtained in 9 patients who had either sustained AIVR (n=7) or sustained VT (n=2) after reperfusion of occluded coronary artery. Arrhythmias were terminated in all patients.

Conclusions—These results indicate that administration of dipyridamole can prevent and terminate reperfusion arrhythmias such as AIVR and VT. cAMP-mediated triggered activity may, at least in part, be responsible for reperfusion-induced AIVR and VT.

Key Words: adenosine • arrhythmia • myocardial infarction • reperfusion

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