A clinical study of hemodynamically significant arrhythmias and QTc interval associated with thrombolysed and non thrombolysed acute myocardial infarction patients
Keywords:Acute myocardial Infarction, Arrhythmias, Electrocardiogram, Sinus Tachycardia, Tachyarrhythmias
Background: Arrhythmias are a common occurrence in acute myocardial infarction. Objectives of this study the hemodynamically significant arrhythmias and QTc interval in thrombolysed and non thrombolysed acute myocardial infarction patients.
Methods: Two hundred patients of AMI were enrolled. ECG and cardiac parameters were examined. Arrhythmias and its various parameters like its incidence, type, frequency associated with site of infarction were recorded in thrombolysed and non thrombolysed patients of AMI.
Results: AMI was more prevalent in the males (63.3%) and those with 41-50 years of age. Hypertension (35.7%), smoking (34.2%), and diabetes (23.1%) were the major risk factor. Incidence of AWMI (30.7%) is higher than IWMI (25.1%). Out of 200 subjects 130 were thrombolysed. Arrhythmias was observed in total 164 patients while 36 patients has no documentation of arrhythmias. Mean QTc was prolonged (546.88ms vs 404.33ms) in patients documented with arrhythmia compared with those who has no arrhythmia. Out of all arrhythmias, ventricular tachycardia was seen in 38% cases with 50% mortality and preponderance to antero lateral MI. Sinus Tachycardia was seen in 22% of cases with preponderance to Antero Lateral MI and persistence of Sinus Tachycardia was a prognostic sign, mortality being 12%. Complete Heart Block were seen with IWMI, incidence being 26%. Bundle Branch Block was common in AWMI (31%) than IWMI (10%).
Conclusion: Tachyarrhythmias are common with AWMI and bradyarrhythmia’s in IWMI. Reperfusion arrhythmias are a benign phenomenon and good indicator of successful reperfusion.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Circulation. 2012 Oct 16;126(16):2020-35.
Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med 2013;368(21):2004-13.
Richard E. Klabunde, Cardiovascular Physiology Concepts. 2012. Accessed At: https://www.cvphysiology.com/Arrhythmias/A008. Accessed on 28 July 19.
Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: The Strong Heart Study. Circulation 2000;101(1):61-6.
Sharafat NI, Khalequzzaman M, Akhtaruzzaman M, Choudhury A, Hasem S, Choudhury T, et al. Prolonged QTc Dispersion Correlates with Coronary Artery Disease in Acute ST Elevated Myocardial Infarction (STEMI). Pacing Clin electrophysiol. PACE 2013;5(2):173-81.
Mhatre MA, Sirur FM, Rajpal DR, Shah MR. A clinical study of arrhythmias associated with acute myocardial infarction and thrombolysis. Int J Res Med Sci. 2017;5(1):335-43.
Teo KK, Ounpuu S, Hawken S, Pandey MR, Valentin V, Hunt D, et al. INTERHEART Study Investigators. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. Lancet 2006;368(9536):647-58.
Anand SS, Islam S, Rosengren A, Franzosi MG, Steyn K, Yusufali AH, et al. Risk factors for myocardial infarction in women and men. Study. European Heart Journal. 2008;29(7):932-40.
Rajhans R, Narayanan M. Assessment of arrhythmias in 50 patients of ST-elevation myocardial infarction after thrombolysis: a 24 hour Holter study. Int J Adv Med. 2017;4(3):734-40.
Chiwhane A, Pradeep S. Study of Rhythm Disturbances in Acute Myocardial Infarction. J Association of Physicians of India. 2018;66(1):1-7.
Tippannavar SH, Shekhanawar MS, Gunasheelan N. The study of arrhythmias following myocardial infarction occurring within one week. J Evolution of Medical and Dental Sci. 2012; 1 (6):1178-86.
Midgette AS, O'Connor GT, Baron JA, Bell J. Effect of intravenous streptokinase on early mortality in patients with suspected acute myocardial infarction. Ann Intern Med. 1990;113(12):961-8.
Michels G, Kochanek M, Pfister R. Life-threatening cardiac arrhythmias due to drug-induced QT prolongation. A retrospective study over 6 years from a medical intensive care unit. Med Klin Intensivmed Notfmed. 2016;111(4):302-9.