Arrhythmias In Acute Myocardial Infarction Research Articles

Evaluating the Efficacy of Interventional Approaches for Cardiac Arrhythmias in Acute Myocardial Infarction

Objective: To assess the effectiveness of interventional treatments for cardiac arrhythmias in acute myocardial infarction (AMI). Methods: Eighty AMI patients admitted between August 2022 and August 2023 were selected and randomly assigned into groups using the random number table method. The control group (n = 40) received conventional thrombolytic treatment, while the observation group (n = 40) underwent percutaneous coronary intervention (PCI). Clinical effects were compared between the two groups. Results: Before treatment, there were no significant differences in heart rate indicators, cardiac function indicators, and physiological indicators between the two groups (P > 0.05). After treatment, the observation group showed significantly improved heart rate indicators, cardiac function indicators, and physiological indicators compared to the control group (P < 0.05). The adverse reaction rates in the observation group were lower than in the control group (P < 0.05). Conclusion: PCI treatment demonstrated significant improvements in heart rate, cardiac function, and physiological indicators among AMI patients, leading to a reduced incidence of adverse reactions such as arrhythmia. The overall effect is deemed significant.

Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction

Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction

Admission hyperglycemia in acute myocardial infarction is associated with an increased risk of arrhythmias: A systematic review and meta-analysis.

BackgroundAdmission hyperglycemia (AH) has shown to be associated with higher mortality rates in acute myocardial infarction (AMI). Malignant arrhythmia is one of the causes of death in AMI; however, it is unclear whether AH is associated with an increased arrhythmia risk. We conducted this systematic review and meta‐analysis to assess the association between AH and arrhythmias in AMI.MethodsWe searched MEDLINE, and Embase databases from inception to September 2021 to identify studies that compared arrhythmia rates between AMI patients with AH and those without. Arrhythmias of interest included ventricular tachyarrhythmias (VA), atrial fibrillation (AF), and atrioventricular block.ResultsThirteen cohort studies with a total of 12,898 patients were included. AH was associated with a higher risk of overall arrhythmias (18% vs 10.3%, pooled odds ratio [OR] = 1.89, 95% confidence interval [CI]: 1.39–2.56, P < .001), VA (16.4% vs 11.1%, pooled OR = 1.56, 95% CI: 1.11–2.18, P = .01), and new onset AF (17.8% vs 6.4%, pooled OR = 2.13, 95% CI: 1.4–3.25, P < .0010. Subgroup analysis of diabetes status regarding overall arrhythmias showed that the increased risk of arrhythmias in the AH group was consistent in both patients with a history of diabetes (18% vs 12.5%, pooled OR = 2.33, 95%CI: 1.2–4.52, P = .004) and without (15.7%. vs 9% pooled OR = 1.35, 95% CI: 1.1–1.66, P = .013).ConclusionAdmission hyperglycemia in AMI was associated with the increased risk of arrhythmias, regardless of history of diabetes mellitus.

Reperfusion Arrhythmia in Acute Myocardial Infarction: Clinical Implication and Management

Reperfusion is a critical component of myocardium survival in acute myocardial infarction to minimize infarct size and improve clinical prognosis. Reperfusion, on the other hand, may result in increased and accelerated myocardial injury, a condition known as reperfusion injury. Following reperfusion, several arrhythmias are observed, and it is called reperfusion arrhythmia. Reperfusion arrhythmia is one manifestation of reperfusion injury. Numerous modest studies have evaluated what reperfusion arrhythmias are defined. It is described as an arrhythmia that occurs immediately or within the first minutes after coronary blood flow is restored. Traditionally, Accelerated Idioventricular Rhythm (AIVR) has been seen as a reperfusion arrhythmia. However, reperfusion may reveal any arrhythmia (or none at all); conversely, AIVR may occur in the absence of reperfusion. Calcium excess within the cells is thought to be a significant factor in the development of reperfusion arrhythmias. This may affect the significant delay following depolarization and the regional heterogeneity of regional blood flow restoration inside the ischemic zone, resulting in reperfusion arrhythmia. In some studies, it was mentioned that these arrhythmias may be due to ongoing myocardial cell damage and ischemia. Arrhythmias associated with reperfusion require special attention since hemodynamics can deteriorate quickly. In this review, clinical significance and management of reperfusion arrhythmia, as well as its link with reperfusion injury will be discussed.

Fibroblast Growth Factor 21 Ameliorates NaV1.5 and Kir2.1 Channel Dysregulation in Human AC16 Cardiomyocytes.

Infarcted myocardium is predisposed to cause lethal ventricular arrhythmias that remain the main cause of death in patients suffering myocardial ischemia. Liver-derived fibroblast growth factor 21 (FGF21) is an endocrine regulator, which exerts metabolic actions by favoring glucose and lipids metabolism. Emerging evidence has shown a beneficial effect of FGF21 on cardiovascular diseases, but the role of FGF21 on ventricular arrhythmias following myocardial infarction (MI) in humans has never been addressed. This study was conducted to investigate the pharmacological effects of FGF21 on cardiomyocytes after MI in humans. Patients with arrhythmia in acute MI and healthy volunteers were enrolled in this study. Serum samples were collected from these subjects on day 1 and days 7–10 after the onset of MI for measuring FGF21 levels using ELISA. Here, we found that the serum level of FGF21 was significantly increased on day 1 after the onset of MI and it returned to normal on days 7–10, relative to the Control samples. In order to clarify the regulation of FGF21 on arrhythmia, two kinds of arrhythmia animal models were established in this study, including ischemic arrhythmia model (MI rat model) and nonischemic arrhythmia model (ouabain-induced guinea pig arrhythmia model). The results showed that the incidence and duration time of ischemic arrhythmias in rhbFGF21-treated MI rats were significantly reduced at different time point after MI compared with normal saline-treated MI rats. Moreover, the onset of the first ventricular arrhythmias was delayed and the numbers of VF and maintenance were attenuated by FGF21 compared to the rhbFGF21-untreated group in the ouabain model. Consistently, in vitro study also demonstrated that FGF21 administration was able to shorten action potential duration (APD) in hydrogen peroxide-treated AC16 cells. Mechanically, FGF21 can ameliorate the electrophysiological function of AC16 cells, which is characterized by rescuing the expression and dysfunction of cardiac sodium current (I Na) and inward rectifier potassium (I k1) in AC16 cells induced by hydrogen peroxide. Moreover, the restorative effect of FGF21 on NaV1.5 and Kir2.1 was eliminated when FGF receptors were inhibited. Collectively, FGF21 has the potential role of ameliorating transmembrane ion channels remodeling through the NaV1.5/Kir2.1 pathway by FGF receptors and thus reducing life-threatening postinfarcted arrhythmias, which provides new strategies for antiarrhythmic therapy in clinics.

Serum uric acid level is associated with reperfusion ventricular arrhythmias in acute myocardial infarction

Background and aimIn the acute phase of acute myocardial infarction (AMI), reperfusion ventricular arrhythmias such as ventricular tachycardia and ventricular fibrillation (Reperfusion VT/VF) resulting from reperfusion injury are one of the causes of in-hospital death. Predicting Reperfusion VT/VF is clinically important. Previous studies have reported that oxidative stress is the cause of reperfusion injury and reperfusion arrhythmia. There are also reports that xanthine oxidase inhibitors have the effect of preventing reperfusion arrhythmia. We hypothesized that hyperuricemia is a risk factor for reperfusion arrhythmias in AMI.The aim of our study is to investigate whether serum uric acid is associated with Reperfusion VT/VF in acute myocardial infarction. MethodThis is a single-center, retrospective cohort study. We enrolled 612 ST elevation myocardial infarction patients who underwent successful primary percutaneous coronary intervention (PCI). We divided patients into a high serum uric acid group (HUA group) and a low serum uric acid group (LUA group) with a cutoff value of 7.0 mg/dl, which is the standard value of serum uric acid. We compared the frequency of Reperfusion VT/VF in both groups. ResultThere were 111 patients in the HUA group and 512 patients in the LUA group. Creatinine tended to be higher in the HUA group than in the LUA group. (1.12 ± 0.41 mg/dl VS 0.92 ± 1.10 mg/dl P = 0.06). The frequency of Reperfusion VT/VF was significantly higher in the HUA group than in the LUA group (17.1% VS 4.0% P < 0.001). ConclusionElevated serum uric acid is associated with higher frequency of reperfusion ventricular arrhythmia.

ECG—An Axis Dilemma with Tachycardia

Abstract Cardiac arrhythmias are common in acute myocardial infarction (MI), especially in ST elevation MI. Almost 90% of patients develop some form of cardiac arrhythmia in acute MI. Mostly they are benign and transient. Incidence of atrial tachycardia is fairly uncommon in such setting. Most of the arrhythmias disappear after reperfusion. Interpretation of electrocardiograms (ECGs) in emergency becomes even more difficult if there is unusual QRS axis and possibility of arm lead reversal.

Arrhythmia in Acute Myocardial Infarction: A Six-Month Retrospective Analysis From the National Institute of Cardiovascular Diseases.

IntroductionAcute myocardial infarction (AMI) is a devastating medical emergency that requires immediate pharmacological and radiological intervention. With the advent of techniques such as percutaneous coronary intervention (PCI), pacemakers, and percussion pacing, survival rates have improved significantly. However, there are certain factors and complications associated with AMI that still lead to a high mortality rate, such as old age, advanced heart disease, diabetes mellitus (DM), and arrhythmias.Factors such as the type of arrhythmia, the heart rate, and the level at which dissociation occurs between atrial and ventricular rhythm all influence mortality and morbidity rates. Outcomes are further influenced by the sex of the patient, the type of AMI [ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI)], history of smoking, arrival times at the hospital, presence of hyperglycemia, previous history of cardiac surgery, and the need for a temporary pacemaker or a permanent pacemaker.As with most scientific studies, local data from Pakistan is hard to find on this topic as well. With this study, we hope to contribute valuable information and updates to the study of a developing problem from the developing world.ObjectiveWe aimed to analyze the frequency and outcomes of different types of arrhythmia in AMI.MethodsThis study involved a retrospective observational cohort. It was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi from January 2019 to July 2019 (six months). All data were retrieved from the online database at the NICVD. Written consent was obtained from all patients. Patient confidentiality was ensured at all times.ResultsA total of 500 patients were included in the study. The mean age of our cohort was 56.17 ±14.01 years. NSTEMI was more prevalent than STEMI. Sinus arrhythmia (SA) was the most frequently recorded arrhythmia and had the best survival rates. Atrioventricular (AV) nodal blocks and ventricular tachycardia (VT) had the worst outcomes. The overall mortality rate was 11.4%, and the mean in-hospital length of stay was 2.07 ±1.54 days. Smoking increased mortality in all cases.ConclusionsAMI is complicated by several types of arrhythmia. SA is the most common arrhythmia in AMI. Mortality in AMI is largely due to AV nodal blocks and VT. Smoking increases mortality in all cases.

Burden of Arrhythmias in Acute Myocardial Infarction Complicated by Cardiogenic Shock

There are limited data on arrhythmias in acute myocardial infarction with cardiogenic shock (AMI-CS). Using a 17-year AMI-CS population from the National Inpatient Sample, we identified common arrhythmias - atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, and atrioventricular blocks (AVB). Admissions with concomitant cardiac surgery were excluded. Outcomes of interest included temporal trends, predictors, in-hospital mortality, and resource utilization in cohorts with and without arrhythmias. Of the 420,319 admissions with AMI-CS during 2000 to 2016, arrhythmias were noted in 213,718 (51%). AF (45%), ventricular tachycardia (35%) and ventricular fibrillation (30%) were the most common arrhythmias. Compared with those without, the cohort w`ith arrhythmias was more often male, of white race, with ST-segment elevation AMI-CS presentation, and had higher rates of cardiac arrest and acute organ failure (all p <0.001). Temporal trends of prevalence revealed a stable trend of atrial and ventricular arrhythmias and declining trend in AVB. The cohort with arrhythmias had higher unadjusted (42% vs 41%; odds ratio [OR] 1.03 [95% confidence interval 1.02 to 1.05]; p <0.001), but not adjusted (OR 1.01 [95% CI 0.99 to 1.03]; p = 0.22) in-hospital mortality compared with those without. The cohort with arrhythmias had longer hospital stay (9 ± 10 vs 7 ± 9 days; p <0.001) and higher hospitalization costs ($124,000 ± 146,000 vs $91,000 ± 115,000; p <0.001). In the cohort with arrhythmias, older age, female sex, non-white race, higher co-morbidity, presence of acute organ failure, and cardiac arrest, predicted higher in-hospital mortality. In conclusion, cardiac arrhythmias in AMI-CS are a marker of higher illness severity and are associated with greater resource utilization.

Clinical risk factors for new-onset atrial fibrillation in acute myocardial infarction: A systematic review and meta-analysis.

New-onset atrial fibrillation (NOAF) remains common arrhythmia in acute myocardial infarction (AMI), and is closely associated with increased subsequent cardiovascular mortality. Our meta-analysis aims to summarize more clinical risk factors for NOAF.Comprehensive systematic search of MEDLINE, EMBASE, and the Cochrane Library were carried out to find relevant studies inception to December 2017. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate the value of clinical risk factors in the prediction of NOAF after AMI.Eleven studies containing 9570 patients were included in the meta-analysis. Overall, older age and increased heart rate (HR) levels had a significant positive association with NOAF in patients with AMI. The MD in age between the patients with, and those without NOAF, was 8.22 units (95% confidence interval [CI]: 7.44-9.01), test for overall effect z score = 20.51 (P < .00001, I = 0%). Moreover, the MD in a subgroup analysis for HR levels between the patients with, and those without NOAF was 4.34 units (95% Cl: 2.56-6.11), test for overall effect z score = 4.78 (P < .00001, I = 31%).In patient with AMI, our meta-analysis demonstrated that older age and increased HR levels on admission are related to greater risk of NOAF.

Frequency of Ventricular Arrhythmias in Acute Myocardial Infarction and its relationship with Hypokalemia

Introduction: Arrhythmic complications of acute myocardial infarction like ventricular arrhythmias are common and determine the clinical outcome. The associated risk factors like potassium level may help triage the patients to reduce mortality.

Modifier genes for sudden cardiac death.

Genetic conditions, even those associated with identical gene mutations, can present with variable clinical manifestations. One widely accepted explanation for this phenomenon is the existence of genetic factors capable of modifying the consequences of disease-causing mutations (modifier genes). Here, we address the concepts and principles by which genetic factors may be involved in modifying risk for cardiac arrhythmia, then discuss the current knowledge and interpretation of their contribution to clinical heterogeneity. We illustrate these concepts in the context of two important clinical conditions associated with risk for sudden cardiac death including a monogenic disorder (congenital long QT syndrome) in which the impact of modifier genes has been established, and a complex trait (life-threatening arrhythmias in acute myocardial infarction) for which the search for genetic modifiers of arrhythmic risk is more challenging. Advances in understanding the contribution of modifier genes to a higher or lower propensity towards sudden death should improve patient-specific risk stratification and be a major step towards precision medicine.

Incidence of cardiac arrhythmias in patients with acute myocardial infarction during the first 48 hours of the onset of chest pain

Background: It is predicted that there will be an increase of 111% in cardiovascular deaths in India by the year 2020 compared to the year 1990. This is much higher than that predicted in any other region both in Asia as well as outside Asia. The objective of this study was to study the incidence of cardiac arrhythmias in acute myocardial infarction during the first 48 hours.Methods: The descriptive study was conducted over a period of two years from April 2016 to January 2017. A total of 102 patients were studied. They were admitted to ICU. Their admission was done as soon as they had chest pain. They were first confirmed to have acute myocardial infarction. All eligible study subjects as per inclusion and exclusion criteria were considered in the present study. Detailed history was taken. A thorough physical examination was done with emphasis on the cardiovascular system.Results: Maximum number of patients was in the age group 51-60 years in both males (37.97%) and females (65.22%). Acute MI observed mostly in the postmenopausal age in all the females. Incidence of myocardial infarction was significantly more in men (77.50%) compared to women (22.50%). 52.90% were smokers. Almost half of the patients had shown anterior wall infarction. The incidence of cardiac arrhythmias was 78.70%. Arrhythmias were more common among elderly female. Maximum arrhythmias were observed in the age group ranging from 50 to 60 years (36.27%).Conclusions: The incidence of cardiac arrhythmia was found to be 78.7% in the present study. The incidence of cardiac arrhythmia was more in the age group 50-60 years (36.27%).

Assessment of arrhythmias in 50 patients of ST-elevation myocardial infarction after thrombolysis: a 24 hour Holter study

Background: Acute coronary syndrome represents a global epidemic. The purpose of this study was to evaluate the incidence of cardiac arrhythmias in acute myocardial infarction (AMI) in the first 24 hours of hospitalization post thrombolysis.Methods: 50 patients of AMI satisfying the inclusion criteria were included for this observational study. Philips Digitrak Holter was attached to the patient's chest for 24 hours and arrhythmias were noted.Results: In the study group 70% of cases were males, rest 30% females. Maximum incidence of AMI was seen between 4th and 7th decade of life. Incidence of diabetes and hypertension were 54% and 66% respectively either alone or in combination. Overall incidence of anterior wall was higher 56% than inferior wall which was 44%. Sinus tachycardia was seen in 54% of cases with higher incidence in anterior wall MI. Among the reperfusion arrhythmias incidence of frequent VPCs was highest with 66% followed by AIVR (42%) and NSVT (30%). AF was found in 3 cases i.e. 6% of which one died. One patient had VF to which she succumbed.Conclusions: It is a matter of debate whether arrhythmias being so common in AMI, should be considered under clinical spectrum or complication of AMI. An increasing belief that less serious arrhythmias may serve as a warning sign for potentially life threatening arrhythmias and timely intervention by drugs, D.C. shock or pacemakers can prevent mortality in these sets of patients.

Study of cardiac arrhythmias in acute myocardial infarction within 48 hours

Background: The profile of coronary artery disease is different in India in terms of incidence and risk factors. Indians show higher incidence of hospitalization, morbidity and mortality than other ethnic groups. Majority of deaths in acute myocardial infarction are due to arrhythmias. These would suggest that more aggressive identification and modulation of cardiac arrhythmias in acute myocardial infarction is necessary among Asian Indian. This study is undertaken to study the profile of arrhythmias in acute myocardial infarction within in 48 hours of hospitalization in our hospital.Methods: This study was conducted in KMCH, Katihar, Bihar, India. A total of 50 (38 males, 12 females) patients admitted to the coronary care unit with diagnosis of acute myocardial infarction were included to the study. Patients were monitored for 48 hours and pattern of arrhythmias were noted.Results: 38 males and 12 females were studied. 65% of the patients were thrombolysed. Arrhythmia was seen in 78% of the patients. 70% of the arrhythmias occurred during the first hour. 58% of the arrhythmias underwent spontaneous resolution. 23% of the patients had sinus bradycardia.Conclusions: The present study suggests that majority of the patients with acute myocardial infarction had arrhythmias. Sinus bradycardia was the commonest arrhythmia, followed by ventricular premature contractions. However ventricular premature contractions also occurred along with other arrhythmias.

MiR-223-3p as a Novel MicroRNA Regulator of Expression of Voltage-Gated K+ Channel Kv4.2 in Acute Myocardial Infarction

Background/Aims: Acute myocardial infarction (AMI) is a devastating cardiovascular disease with a high rate of morbidity and mortality, partly due to enhanced arrhythmogenicity. MicroRNAs (miRNAs) have been shown to participate in the regulation of cardiac ion channels and the associated arrhythmias. The purpose of this study was to test our hypothesis that miR-223-3p contributes to the electrical disorders in AMI via modulating KCND2, the gene encoding voltage-gated channel Kv4.2 that carries transient outward K⁺ current I_to. Methods: AMI model was established in male Sprague-Dawley (SD) rats by left anterior descending artery (LAD) ligation. Evans blue and TTC staining was used to measure infarct area. I_to was recorded in isolated ventricular cardiomyocytes or cultured neonatal rat ventricular cells (NRVCs) by whole-cell patch-clamp techniques. Western blot analysis was employed to detect the protein level of Kv4.2 and real-time RT-PCR to determine the transcript level of miR-223-3p. Luciferase assay was used to examine the interaction between miR-223-3p and KCND2 in cultured NRVCs. Results: Expression of miR-223-3p was remarkably upregulated in AMI relative to sham control rats. On the contrary, the protein level of Kv4.2 and I_to density were significantly decreased in AMI. Consistently, transfection of miR-223-3p mimic markedly reduced Kv4.2 protein level and Ito current in cultured NRVCs. Co-transfection of AMO-223-3p (an antisense inhibitor of miR-223-3p) reversed the repressive effect of miR-223-3p. Luciferase assay showed that miR-223-3p, but not the negative control, substantially suppressed the luciferase activity, confirming the direct binding of miR-223-3p to the seed site within the KCND2 sequence. Finally, direct intramuscular injection of AMO-223-3p into the ischemic myocardium to knockdown endogenous miR-223-3p decreased the propensity of ischemic arrhythmias. Conclusions: Upregulation of miR-223-3p in AMI repressed the expression of KCND2/Kv4.2 resulting in reduction of I_to density that can cause APD prolongation and promote arrhythmias in AMI, and therefore knockdown of endogenous miR-223-3p might be considered a new approach for antiarrhythmic therapy of ischemic arrhythmias.

Study of Arrhythmias in Acute Myocardial Infarction

Background: Acute Coronary Syndrome (ACS) represents a Global epidemic. There is not much documented evidence regarding the profile of arrhythmias in the present population of Shimoga. Hence the purpose of this study is to evaluate the incidence and profile of cardiac Arrhythmias in AMI in the first week of hospitalization in a tertiary care hospital in shimoga, karnataka. Material and Methods: 100 patients of Acute Myocardial Infarction (AMI) admitted to ICCU of Mc Gann Hospital from April 2015 to June 2015 were studied. The first electrocardiogram (ECG) was recorded at the earliest after admission, subsequently at four hourly interval on first day, daily for the duration of stay and as &amp; when needed, cardiac enzymes and 2D echocardiography were done to confirm MI. Result: The mean age was 52.914  13.19 years with male to female ratio being 2.9:1. Incidence of arrhythmias was 89%, majority (67%) of arrhythmias occurred during first 24 hours. Sinus tachycardia (48%), ventricular premature beats (VPCs) (24%), Sinus bradycardia (22%) and atrial premature complexes (15%) were common arrhythmias encountered in study. Atrioventricular blocks (93.4%) were more common in inferior wall infarctions. Arrhythmias were documented in 90.91% of anterior wall MIs, 83.33% of inferior wall MIs and 100% of combined (anterior and inferior) MIs. Conclusion: Our observations confirmed the differences in the occurrence of arrhythmias in different setup and locality and need for individualization of management protocol in different setup.

Use of Extracorporeal Membrane Oxygenation to Rescue Patients With Refractory Ventricular Arrhythmia in Acute Myocardial Infarction.

Refractory ventricular arrhythmia is a serious problem in acute myocardial infarction (AMI), with an extremely high mortality rate and limited effective treatment. Extracorporeal membrane oxygenation (ECMO) is useful to rescue patients with cardiopulmonary collapse. However, little is known about whether ECMO is a potential rescue technique for patients with refractory ventricular arrhythmia in AMI.We retrospectively analyzed prospectively collected data on patients with AMI and refractory ventricular arrhythmia who underwent ECMO as rescue therapy and the bridge to revascularization from February 2001 to January 2013. Primary endpoint was mortality on index admission, and secondary endpoint was mortality on index admission or advanced brain damage at discharge.A total of 69 (62 men) patients were enrolled in this study. During the index admission, 39 patients (56.5%) met primary endpoint, and 45 patients (65.2%) met secondary endpoint, respectively. In multivariate Cox regression analysis, both the presence of profound anoxic encephalopathy and acute renal failure requiring dialysis were significant predictive factors for both primary and secondary endpoints.ECMO is a feasible rescue therapy and bridge to revascularization in patients with refractory ventricular arrhythmia in acute myocardial infarction. The presence of profound anoxic encephalopathy and acute renal failure requiring dialysis were significant prognostic factors.

Modern clinical retrospective on ventricular rhythm disturbances in acute myocardial infarction: Latest treatment mode according to the valid recommendations

Ventricular arrhythmias are the most common cause of mortality in patients with acute myocardial infarction. Arrhythmias in acute coronary syndrome occur because of unbalanced function of the autonomic nervous system, because of electrolyte status disturbances (hypokalemia, hypomagnesaemia, intracellular hypercalcemia) and because of slow conduction in ischemical myocardium zones. Arrhythmias contribute to acidosis and release of free oxygen radicals occurring during reperfusion of ischemic myocardium. Ventricular arrhythmias in acute myocardial infarction indicate the presence of extensive myocardial damage at a reduced left ventricular ejection fraction, and not infrequently in the formation of an aneurysm of the left ventricle. In patients with acute coronary syndrome, the most common ventricular arrhythmias are premature ventricular beats, ventricular tachycardia, ventricular flutter and fibrillation and accelerated idioventricular rhythm. Ventricular fibrillation, still the leading cause of sudden death in patients with acute coronary syndrome within the first four hours of myocardial infarction, occurs in 80 % of all ventricular fibrillations. The use of beta-blockers in the first 24 hours of acute myocardial infarction in patients with early ventricular fibrillation and tachycardia does not affect the degree of worsening heart failure and is directly associated with reduced rates of early mortality in these patients. Quick and adequate treatment of ventricular arrhythmias is a major advancement in the treatment of acute myocardial infarction.

Reappraisal of temporal dispersion of arrhythmias in acute myocardial infarction after thrombolysis in initial 24 hours of presentation

Reappraisal of temporal dispersion of arrhythmias in acute myocardial infarction after thrombolysis in initial 24 hours of presentation