Study of Bradyarrhythmias in Acute Myocardial Infarction

Abstract

Abstract Background Arrhythmias after acute myocardial infarction are common. Bradyarrhythmias need specific insight into when and how to treat them. Objective Is to delineate the incidence, course, and management of different types of bradyarrhythmia after acute myocardial infarction, study period was 5 years. Methods Four hundred and fifty-three patients with acute myocardial infarction (AMI) were admitted to intensive care in 5 years. ECGs were analyzed for the presence of bradyarrhythmias and details of management. Results Sixty-five patients with bradycardia were found. Sinus bradycardia in 40, sick sinus syndrome in 10, junctional rhythm in 10, second-degree block in 10, complete heart block in 24. We divided patients with sinus bradycardia into stable and unstable. Unstable sinus bradycardia is more prevalent in cases with hypotension or shock, slower heart rates, gross or transmural infarction, changeable morphology of the P wave, and inferior rather than anterior infarction. The indications and danger of atropine are defined. Complete heart block was found in 24 patients (0.053%). Thirteen were managed by drug therapy (isoprenaline, corticosteroids, and atropine); 11 were paced. Fourteen out of the 24 patients died (58%), the total mortality rate among the 453 patients was 22%. The prognostic factors of CHB were defined. Techniques of introducing lead in RV without fluoroscopy are described. Conclusions Sinus bradycardia in AMI is accompanied by a lower incidence of mortality. Atropine is not a safe drug to be given as routine. Complete heart block predictors of mortality are the association with heart failure, early onset, and persistence of the block.

Keywords

• acute myocardial infarction
• atropine
• bradyarrhythmias
• complete heart block
• temporary pacemakers