Necropsy evaluation in seven patients with evolving acute myocardial infarction treated with thrombolytic therapy

Endo-Epicardial Homogenization of the Scar Versus Limited Substrate Ablation for the Treatment of Electrical Storms in Patients With Ischemic Cardiomyopathy

“…In the pre-thrombolytic era, persistent occlusion of the infarctrelated artery generated an area of transmural necrosis, ultimately leading to a central fibrotic core with a thin border zone with viable bundles of myocytes interspersed among healed fibrotic tissue (16). The introduction of pharmacological and mechanical reperfusion therapies has led to a higher percentage of nontransmural necrosis, with heterogeneous infarct cores containing bundles of surviving myocytes and fibrotic tissue surrounded by similarly complex border zones merging into normal myocardium (16).…”

“…The complex anatomy of the endocardial scar and multiple potential reentrant pathways as well as initiators represents the main limitations of VAs ablation (15)(16)(17)(18)(19). This is why a limited substrate ablation might abolish circuits relevant to the arrhythmia burden at the time of the procedure (4,14).…”

Substrate mapping for unstable ventricular tachycardia

“…Early reperfusion typically results in non-transmural necrosis, with highly heterogeneous infarct cores containing larger bundles of surviving myocytes mixed with fibrotic tissue, surrounded by similarly complex border zones merging into normal myocardium. 33 These patchy areas of abnormality may also be identified in patients with VT in the setting of NICM, and can be missed using a fixed bipolar voltage cut-off value of 1.5 mV. Indeed, these regions may be characterized by a large nearfield bipolar components and small amplitude lower frequency far-field subendocardial signals or vice versa.…”

A randomized trial of coronary stenting versus balloon angioplasty as a rescue intervention after failed thrombolysis in patients with acute myocardial infarction

“…Although a high proportion of patients in both groups received abciximab as adjunct antithrombotic therapy, the rate of bleeding complications was low (4%) in both study groups. Because the risk of thrombotic formation after failed thrombolysis may be high as a result of predisposing lesion characteristics (16) and post-thrombolytic platelet activation (17,18), the findings of the present study may support the use of abciximab as adjunct antithrombotic therapy during rescue mechanical reperfusion.…”

“…The fact that failed thrombolysis is more likely associated with complex atherosclerotic plaques (16) and that postthrombolytic state leads to a greater degree of platelet activation than that seen in the setting of AMI (17,18) may explain the less than optimal efficacy of rescue angioplasty in the setting of failed thrombolysis. Although coronary stenting may offer advantages over angioplasty in the acute phase of myocardial infarction (19), only limited research on small series of patients has been performed to date with regard to the efficacy of rescue stenting in the setting of failed thrombolysis (20 -22).…”