Control of ventricular arrhythmias by an antilipolytic treatment used during acute myocardial infarction in man

• Main Author: Rowe, M. J.
• Published: University of Edinburgh 1978
• Subjects: 616.1
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.661428

Coronary heart disease is in 1977 the leading cause of death in nearly all industrialised countries. The majority of deaths occur within 1 hour of the onset of symptoms of a heart attack and the principal cause of death is ventricular fibrillation. The purpose of the work presented in this thesis is fourfold: 1. to review the literature on the relevance of cardiac arrhythmias to death from coronary heart disease; 2. To assess the evidence that, following acute myocardial infarction, a combination of local and systemic metabolic changes may increase the frequency of cardiac arrhythmias; 3. To propose that in man, one of these changes, a rise in plasma concentration of free fatty acids, can be reversed in the acute phase of myocardial infarction by the administration of a nicotinic acid analogue; 4. To test by a controlled clinical trial the hypothesis that (a) such administration would reliably result in a lowering of free fatty acids concentrations, and (b) that this lowering of free fatty acids would result in a reduction in the incidence of ventricular arrhythmias. The results obtained from pilot studies and a double blind trial demonstrate: i) that free fatty acids can be lowered safely in man with acute myocardial infarction; ii) that where free fatty acids were successfully lowered within 5 hours of the onset of symptoms of a heart attack, there was a reduction in the incidence of ventricular arrhythmias. This work is the only known clinical test of the hypothesis that raised plasma free fatty acids may cause ventricular arrhythmias during acute myocardial infarction in man.