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

Rishi Rajhans, M. Narayanan


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.


AMI, Arrhythmias, NSVT, Ventricular fibrillation, VPC

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Krishnan MN. Coronary heart disease and risk factors in India- On the brink of an epidemic? Indian Heart J. 2012;64(4):364-7.

Centers for Disease Control and Prevention (CDC). Prevalence of coronary heart disease- United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011;60(40):1377-81.

Perron AD, Sweeney T. Arrhythmic complications of acute coronary syndromes. Emerg Med Clin North Am. 2005;23(4):1065-82.

Standring S. Heart and great vessels. In: Gray's Anatomy. 39th ed. London: Elsevier Churchill Livingstone; 2005: 996-1020.

Martin TC, Van Longhuyzen H, Bennett B, Peterson S, Beazer C, Thomas CV. The age-specific incidence of admission to the intensive care unit for acute myocardial infarction in Antigua and Barbuda. West Indian Med J. 2007;56(4):326-9.

Berger JS, Brown DL. Gender age interaction in early mortality following primary angioplasty for acute myocardial infarction. Am J Cardiol. 2006;198(9):1140-3.

Ivanusa M, Milicic D, Bozikov J, Ivanusa Z. Risk factors as prognostic factors of hospital mortality in patient with acute myocardial infarction. Acta Med Croatica. 2007;61(3):307-13.

Rosengren A, Wallentil L, Gitt KA, Behar S, Battler A, Hasdai D. Sex, age and clinical presentation of acute coronary syndrome. Eur Heart J. 2004;25(8):663-70.

Svensson AM, Dellborg AM, Abrahamsson P, Karlson T, Herlitz J, Duval SJ, et al. The influence of a history of diabetes on treatment and outcome in acute myocardial infarction, during two periods and in two different countries. Int J Cardiol. 2007;119(3):319-25.

Kokubo Y, Kamide K, Okamura T, Watnabe M, Higashiyama A, Kawanishi K, et al. Impact of high-normal blood pressure on risk of cardiovascular disease in a Japanese urban cohort: the Suita study.Hypertension 2008;52(4):652-9.

Nagabhushana S, GK RK, Ranganatha M, Virupakshappa V. Study of Arrhythmias in Acute Myocardial Infarction. Int J Med Res Rev. 2015;3(7):682-690.

Shah MJ, Bhatt NR, Dabhi A, Thorat PB, Chudasama K, Patel J. A study of 100 cases of arrhythmias in first week of acute myocardial infarction (AMI) in Gujarat: a high risk and previously undocumented population. J Clin Diagn Res: JCDR. 2014;8(1):58.

Malla RR, Sayami A. In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction. JNMA J Nepal Med Assoc. 2007;46(167):99-102.

Crimm A, Severance HW, Coffey K, McKinnis R, Wagner GS, Califf RM. Prognostic significance of isolated sinus tachycardia during first three days of acute myocardial infarction. Am J Med. 1984;76(6):983-8.

Novaro GM, Asher CR, Bhatt DL, Moliterno DJ, Harrington RA, Lincoff AM, et al. Meta-analysis comparing reported frequency of atrial fibrillation after acute coronary syndromes in Asians versus whites. Am J Cardiol. 2008;101(4):506-9.

Rathod S, Parmar P, Rathod GB, Parikh A. Study of various cardiacarrhythmias in patients of acute myocardial infarction: Int Arch Int Med. 2014;1(4):32-41.

Majumder AA, Malik A, Zafar A. Conduction disturbances in acute myocardial infarction: incidence, site-wise relationship and the influence on in-hospital prognosis. Bangladesh Med Res Counc Bull. 1996;22(2):74-80.

Pop T, Erbel R, Treese N, von Olshausen K, Meyer J. Incidence and kind of reperfusion arrhythmias in thrombolytic therapy of acute myocardial infarct. Z Kardiol. 1987;76(2):81-5.

Gibson CM, Pride YB, Buros JL, Lord E, Shui A, Murphy SA, et al. Association of impaired thrombolysis in myocardial infarction myocardial perfusion grade with ventricular tachycardia and ventricular fibrillation following fibrinolytic therapy for ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2008;51(5):546-51.

Al-Khatib SM, Stebbins AL, Califf RM, Lee KL, Granger CB, White HD, et al. Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial. Am Heart J. 2003;145(3):515-21.

Tatli E, Alicik G, Buturak A, Yilmaztepe M, Aktoz M. Arrhythmias following revascularization procedures in the course of acute myocardial infarction: are they indicators of reperfusion or ongoing ischemia? Scient World J. 2013;2013:e160380.

Ghuran AV, Camm AJ. Ischaemic heart disease presenting as arrhythmias. Br Med Bull. 2001;59:193-210.