Abstract P18: Acute Hemodynamic Effects of Accelerated Idioventricular Rhythm in Primary Percutaneous Coronary Intervention
Purpose Hemodynamic effects of accelerated idioventricular rhythm (AIVR) in primary percutaneous coronary intervention (PCI) are poorly described. Therefore, we systematically assessed direct hemodynamic effects of AIVR.
Methods In this prospective cohort study, 75 consecutive patients with AIVR following reperfusion in primary PCI were analysed. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were determined during periods of AIVR and sinus rhythm (SR). We grouped patients according to IRA, i.e. right coronary artery (RCA) or left coronary artery (LCA) and site of coronary occlusion, i.e. proximal and distal occlusions.
Results AIVR compared to SR, resulted in a significant transient reduction in both SBP and DBP irrespective of IRA and location. Moreover, this drop in SBP was more pronounced in distal LCA occlusions.(see Figure⇓)Mean SBP in proximal LCA occlusions during SR was significantly lower than in distal LCA occlusions (119±17 vs.144±23 mmHg, p<0.002) with a concomitant higher heart rate (84±11 vs.75±10 bpm, p<0.01).Mean SBP in proximal RCA occlusions during SR was similar to distal RCA occlusions.(122±30 vs.115±29 mmHg, p=NS) without a difference in heart rate (79±8 vs.79±14 bpm, p=NS)
Conclusion The occurrence of AIVR following reperfusion is associated with a significant decline in both SBP and DBP, irrespective of the IRA and site of occlusion. Patients with a distal LCA occlusion showed more pronounced reduction in SBP compared to patients with a proximal occlusion. This phenomenon is probably the result of a more compromised hemodynamic condition in proximal LCA occlusions as demonstrated by a lower SBP and increased heart rate.