Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours

Abstract

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.

Accelerated Idioventricular Rhythm in a Young Athlete

“…The mechanism is accelerated phase 4 depolarization of His-Purkinje fibers or ventricular myocardium. 15 AIVR is associated with cardiac pathology, such as after myocardial infarction, cardiomyopathies, electrolyte disturbances, and with digoxin intoxication, 1 , 2 , 3 but is also seen in patients without any cardiac abnormalities, and has been described in children, adolescents, and athletes. 4 , 5 , 6 , 7 …”

“…AIVR is associated with cardiac pathology and is observed in cardiomyopathies, after myocardial infarction, and during electrolyte disturbances or digoxin intoxication. 1 , 2 , 3 AIVR has also been reported as a benign rhythm variant without evidence of underlying cardiac pathology in children, adolescents, and athletes. 4 , 5 , 6 , 7 …”

“…Therefore, the sports cardiology team advised a multimodal approach, recommending in particular a cardiac magnetic resonance imaging (CMR) document or exclusion of (subtle) structural heart disease, based on the possible association between AIVR and underlying heart disease. 1 , 2 , 3 …”

Ventricular Arrhythmias in Patients Undergoing Primary Percutaneous Coronary Intervention (PCI) for ST-Segment Elevation Myocardial Infarction (STEMI)

“…In line with this study, Mhatre MA et al 13 reported that out of all, ventricular arrhythmias were observed among 33% of participants, among which VT was observed in 24% of the cases, VPB was observed in 8%, while 1% experienced ventricular bigeminy. On the other hand, Shah JA et al 15 conducted the study to assess the prevalence, risk factors, and consequences of cardiac arrhythmias among individuals with AMI receiving PCI within the initial 24 hrs of hospitalization and they observed higher occurrences of arrhythmias among 89.1% of the participants.…”

Spectrum of Cardiac Arrhythmias During Initial 48 Hours of Acute Myocardial Infarction Patients and their Association with in-Hospital Outcome

“…2 Acute Myocardial Infarction(AMI) contributes to a significant proportion of mortality worldwide, much of which is attributed to life threatening arrhythmias. 3 Both supraventricular and ventricular arrhythmias can occur in AMI. Although, with the advances in treatment, the incidence of arrhythmias has reduced significantly but still life threatening arrhythmias occur in considerable proportion of AMI patients undergoing primary Percutaneous Coronary intervention (PCI).…”