Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA)

Abstract

Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.

Ischemic Postconditioning Reduces Reperfusion Arrhythmias by Adenosine Receptors and Protein Kinase C Activation but Is Independent of KATP Channels or Connexin 43

“…Severe ventricular arrhythmias are potentially lethal events during acute myocardial infarction [1]. However, sinus rhythm restoration by electrical or pharmacological antiarrhythmic therapies could be challenging or unavailable [2]. Reperfusion therapies are crucial during acute myocardial ischemia.…”

Accuracy of telephone triage in primary care patients with chest discomfort: a cross-sectional study

“…Indeed, a low urgency allocation does not necessarily mean the ACS is being missed, but that an undesirable risk to patient safety has been taken with the hazard of life-threatening ventricular arrhythmias and sudden death due to severe pumping failure of the heart in those with acute myocardial infarction. 30 31 On the other hand, triage nurses and their supervising GPs increased triage safety by overruling the decision support system adequately, although with significantly increasing over triage. Apparently, the ‘human factor’ is conducive to safety in the current telephone triage process.…”

Updating the Risk Stratification for Sudden Cardiac Death in Cardiomyopathies: The Evolving Role of Cardiac Magnetic Resonance Imaging. An Approach for the Electrophysiologist

“…The scar tissue following an acute coronary syndrome (ACS) constitutes the most common arrhythmogenic substrate in ICM [68][69][70]. Although malignant arrhythmias occurring early after an ACS are caused by abnormal automaticity and triggered activity of hypoperfused myocardial cells, after the formation of the scar, mechanisms of reentry dominate [71].…”