Background Acute myocardial infarction (AMI) is the most life-threatening manifestation of coronary artery diseases. The majority of deaths in AMI are due to arrhythmias. Therefore, the aim of this study was to evaluate the incidence and risk factors and outcomes of cardiac arrhythmias in AMI patients undergoing primary percutaneous coronary intervention (PCI) during the first 24 hours of the index hospitalization. Methodology This prospective observational study was conducted at the adult cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Patients undergoing primary PCI were included in this study. All the patients were kept under observation for the first 24 hours of AMI and monitored through telemetry system monitoring and the incidence of cardiac arrhythmias and the outcomes were recorded. Results A total of 110 patients were included; the mean age was 59.6±13.1 years. Most of them were male (70.9%). Arrhythmias were observed in 89.1% of the patients, with 169 episodes. The accelerated idioventricular rhythm was the most common type of arrhythmia (37.3%) followed by sinus tachycardia (36.4%), ventricular tachycardia (22.7%), and complete heart block (20.0%). Lethal arrhythmias were observed in 64.5% (71) of the patients. During the hospital course, 65.5% developed arrhythmias during arrival to balloon time, 30% during the procedure, and 53.6% within 24 hours of the procedure. The in-hospital mortality rate was 15.5% with a significant association with the development of lethal arrhythmias within 24 hours of the procedure (21.1% vs. 5.1%; p=0.026). Conclusions The incidence of arrhythmias within 24 hours of hospitalization is high in patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI, and it has been observed to be associated with an increased rate of in-hospital mortality.

Objectives: This study aimed to evaluate the burden and trends of non-rheumatic valvular heart disease (VHD) in Pakistan compared to the South Asian (SA) and Global figures based on estimates of the Global Burden of Disease (GBD) study for the years 1990 to 2019. Methodology: Data for the estimated prevalence, deaths, and disability-adjusted life years (DALYs), along with age-standardized death rate (ASDR) due to non-rheumatic VHD in Pakistan, was extracted from the GBD study. Results: The prevalence of non-rheumatic VHD in Pakistan increased by 14.1% from 1990 to 2019, from 6.4 to 7.3/100,000. The ASDR per 100,000 population has shown a 12.9% increase between the years 1990 and 2019 (from 1.32 to 1.49) with an IRR of 1.102 [1.002-1.1983]. However, global and SA's decreased slightly with an IRR of 0.997 [0.971-1.024] and 0.996 [0.959-1.034]. The estimated number of deaths has shown a 1.1% increase from 0.6 to 0.6/100,000 from 1990 to 2019. Similarly, the estimated number of DALYs has shown an increased (17%) from 14.1 in 1990 to 16.5/100,000 in 2019. Interestingly, Sindh, Baluchistan, and Azad Jammu & Kashmir also had seen the most significant increase in DALYs over 30 years, accounting for 30.3%, 23.7%, and 23.9% respectively. Conclusion: Based on the analysis of GBD estimates, it can be concluded that, in Pakistan, the prevalence, deaths, and DALYs rate of non-rheumatic VHD per 100 thousand individuals increased substantially between 1990 and 2019. The age-standardized death rate also significantly increased over the past 30 years.