Study of Bradyarrhythmias in Acute Myocardial Infarction

摘要

Background: Arrhythmias after acute myocardial infarction are common. Bradyarrhythmias need specific insight into when and how to treat them. Objectives: To delineate the incidence, course, and management of different types of bradyarrhythmias after acute myocardial infarction, the study period was five years. Methods: 453 patients with Acute Myocardial Infarction (AMI) were admitted to intensive care in five years. ECGs were analyzed for the presence of bradyarrhythmias and details of management. Results: 65 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 a stable group and an unstable group. Unstable sinus bradycardia is more prevalent in cases with hypotension or shock, slower heart rates, gross or transmural infarction. Also, predictors of instability were 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%). 13 were managed by drug therapy (isoprenaline, corticosteroids, and atropine);Eleven patients were paced. 14 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 introduction of the 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.