265 The Timing of Arrhythmia Post-STEMI: A Retrospective Audit

Abstract

Little is known about the detection of significant arrhythmias post-STEMI in contemporary populations with high rates of reperfusion therapy. We sought to determine the type and timing of arrhythmias in continuously monitored STEMI patients. A retrospective audit of the Electronic Medical Record of STEMI patients presenting to Concord Hospital from August 6th 2018 to August 4th 2019 was performed. The type and timing of significant arrhythmias and cause of death were reported. 64 patients were included; the mean age±SD was 65±15 years, with male predominance (89%). The culprit lesions were predominantly RCA(48%) and LAD(34%). The majority(88%) received primary PCI, 12% were thrombolysed. 19/64[30%] had clinically significant arrhythmias, 16/64[25%] had LVEF <40% and 11/64[17%] had ongoing pain post reperfusion. The incidence of significant arrhythmias was: sustained VT 9%, recurrent non-sustained VT 6%, VF 5%, accelerated idioventricular rhythm 2%, complete heart block(CHB) 6%, new atrial arrhythmias 8%. All sustained VT and VF occurred prior to reperfusion(D1). No significant ventricular arrhythmias or CHB occurred after day 3. Only 16% of arrhythmias occurred beyond day 2 and 75% of these were atrial. Four patients died during admission; two from primary ischaemic or arrhythmic causes within the first 48hours; two from secondary multi-organ dysfunction beyond 48hours. Most significant arrhythmias occur prior to reperfusion or within the first 48hours, suggesting there is minimal yield arising from monitoring beyond this point. Reducing cardiac monitoring to 48hours in patients without clinical indication may safely reduce costs associated with continuous cardiac monitoring.