Reperfusion arrhythmias – underestimated cause of sudden cardiac death?

Life-threatening rhythm disturbances in the course of the acute coronary syndrome are assumed to be caused by myocardial ischemia. However, in animal studies, it is reperfusion that brings greater electrical instability, and more often leads to serious arrhythmias, especially when the preceding ischemic period lasts up to 30 min. Studies show that in most individuals who have been successfully resuscitated from ventricular fibrillation associated with coronary artery disease, it is transient and not permanent coronary occlusion that was involved. Additionally, reperfusion-induced lethal arrhythmia often concerns people without atherosclerosis and then it is usually caused by coronary artery spasm. Our hypothesis states, that reperfusion arrhythmias are a significant cause of sudden cardiac death, especially those occurring during sleep, and the problem is underestimated. Little research is published on this issue, and so far, only remnant-like lipoproteins appear to be a promising specific risk factor. We believe that considerable efforts should be made to explore the mechanisms behind reperfusion-induced arrhythmias to apply finally appropriate and effective prevention.