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

Syed Ali Shiram; Muhammad Shabbir; Waheed Ur Rehman; Jahanzab Ali; Mutahir Abbas Virk; Sobia Mehreen; Iftikhar Ahmed; Areeba Imtiaz; Naseem Azad; Azhar Ali Chaudry

doi:10.51253/pafmj.v72iSUPPL-3.9526

Authors

Syed Ali Shiram Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Muhammad Shabbir Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Waheed Ur Rehman Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi, Pakistan
Jahanzab Ali Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Mutahir Abbas Virk Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Sobia Mehreen Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Iftikhar Ahmed Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Areeba Imtiaz Armed Forces Institute of Radiology & Imaging/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Naseem Azad Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Azhar Ali Chaudry Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD)/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v72iSUPPL-3.9526

Keywords:

Arrhythmias, Acute myocardial infarction, In-hospital mortality, NonST-Elevation myocardial infarction, Primary PCI, ST elevation myocardial infarction

Abstract

Objective: To determine the spectrum of arrhythmias during initial 48 hours of AMI and their impact on the in-hospital outcome.

Study Design: Analytical Cross-sectional study.

Place and Duration of Study: This study was conducted at a Tertiary Cardiac Center of Rawalpindi Pakistan from Jun 2021 till Jan 2022.

Methodology: A total of (n=150) patients of Acute Myocardial Infarction (AMI) undergoing immediate or early revascularization and meeting the inclusion and exclusion criteria were included in the study. They were monitored for arrhythmias during initial 48 hours of hospitalization and their in-hospital outcomes were noted on a predesigned Performa.Chi square test applied for arrhythmia association with adverse outcome at 95% confidence interval and 5% margin of error.

Results: This study comprised (n=117; 78%) males and (n=33; 22%) females. Mean age was 62.9 years. ST elevation MI(STEMI) constituted (n=127; 84.7%) and Non-ST Elevation MI (NSTEMI) (n=23;15.3%) of total patients. Arrhythmias documented in overall (n=122;81.3%) patients, 81.8% (n=104) in STEMI and (n=18; 77.2%) in NSTEMI. Sinus tachycardia(n=52;34.7%) was most common rhythm followed by accelerated idioventricular rhythm (n=20;13.4%) and sinus bradycardia
12.7% (n=19). In-hospital mortality was (n=25;16.7%) with p-value=0.009, mostly in patients with ventricular tachycardia/ventricular fibrillation, atrial fibrillationand complete heart block. Other outcomes included (n=23;14.7%) acute left ventricular failure, (n=9; 6%) cardiogenic shock (n=5;3.3%) acute stent thrombosis, (n=2; 1.3%) cerebrovascular accident (CVA)and (n=31; 20.7%) prolonged hospitalization (p-value 0.05).

Conclusion: Arrhythmias are common in acute myocardial infarction during initial 48 hours of presentation with sinus
tachycardia being most common followed by accelerated idioventricular rhythm and sinus bradycardia. Arrhythmias are
associated with increased in-hospital mortality and adverse outcome.