R. Kovalchuk, U. Bahan

Danylo Halytsky Lviv National Medical University

Introduction. Acute coronary syndrome, in particular acute ST-elevation myocardial infarction (STEMI), is often accompanied by complex hemodynamically significant arrhythmias and conduction disorders. Such patients have a worse prognosis compared to patients with sinus rhythm. Arrhythmias in patients with STEMI are facilitated by the presence of comorbidities such as arterial hypertension, diabetes mellitus, obesity, and post-COVID-19 syndrome.

The aim of the study. To elucidate the nature of arrhythmias in patients with acute STEMI induced by various risk factors during the first day after myocardial reperfusion by primary percutaneous coronary intervention.

Materials and methods. The study involved 50 patients aged 45 to 83 years (average age – 63,4 ± 9,6 years; men – 70,97 %, women – 29,03 %), who were treated during 2021-2023 at the cardiology and reperfusion therapy department of Cardio-vascular center of ʺSaint Panteleimon Hospital in Lvivʺ and the infarction department of ʺLviv Regional Clinical Cardiological Centerʺ. The patients under investigation were subjected to daily electrocardiogram (ECG) monitoring for 24 hours after stenting of the infarct-related coronary artery, using a 7-channel ECG recorder Solvaig 06000.7 with computer processing of the recording using the DiaCard2 software. The obtained material was further subjected to software packages Microsoft Excel 2022, Statistica 10.

Results. It was established that among supraventricular rhythm disturbances the most common were premature contractions, the average number of which per patient was significantly higher in the presence of obesity. Similarly high it was in post COVID-19 patients, as well as in those with hypertension. In post-coronavirus infection and in hypertension cases, extrasystoles were often in the form of pairs, triplets, bigemia, and trigemia; paroxysms of supraventricular tachycardia were also recorded in these patients. Among the ventricular arrhythmias also the most frequent were premature cardiac contractions, significantly more oftenly recorded in patients with hypertension and those experienced COVID-19; only in these patients were documented extrasystoles in the form of pairs, triplets, bigeminy, trigeminy, runs of ʺR to Tʺ, which are currently considered as harbingers of life-threatening ventricular arrhythmias. In the presence of hypertension and post-COVID-19, episodes of unstable ventricular tachycardia were also observed.

Conclusions. In patients with STEMI, both supraventricular and ventricular premature contractions and episodes of supraventricular and unstable ventricular tachycardia are quite common during the first day after primary percutaneous coronary intervention with infarct-related coronary artery stenting, which is evidence of myocardial electrical instability. The nature of rhythm disturbances in the presence of hypertension and post-COVID-19 is prognostically unfavorable and indicates a higher risk of lifethreatening arrhythmias in these patients. Myocardial revascularization should be supplemented with optimal medical treatment in order to prevent the adverse cardiovascular events in post-STEMI patients. Further research should be directed toward elucidation of predictive value of detected arrhythmias with respect to the occurrence of unfavorable cardiovascular events in the early and long-term post-infarction period.

References

1. 2019 ESC Guidelines for themanagement of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2019;1-65.
2. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2020;1-125.
3. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death Developed by the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). Eur Heart J. 2022;1-130.
4. 2023 ESC Guidelines for the management of acute coronary syndromes Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. 2023;1-107.
5. Batra G, Svennblad B, Held C, Jernberg T, Johanson P, Wallentin L et al. All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome. Heart. 2016;102(12):926-933. https://doi.org/10.1136/heartjnl-2015-308678
6. Chung-Wah S, Man-Hong J, Hee-Hwa H, Raymond M, Stephen W.L. L, Chu-Pak L et al. Transient atrial fibrillation complicating acute inferior myocardial infarction: Implications for future risk of ischemic stroke. Chest. 2007;132(1):44-49. https://doi.org/10.1378/chest.06-2733
7. Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, Camm A, Hindricks G, Huber K et al. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Europace. 2014;16(11):1655-1673. https://doi.org/10.1093/europace/euu208
8. Ismail SM. Significance of 24-hour holter monitoring in acute ST-elevation MI in the early post-infarction period. J Evol Med Dent Sci. 2019;8(23):1862-1866. https://doi.org/10.14260/jemds/2019/409
9. Liang JJ, Fender EA, Cha Y-M, Lennon RJ, Prasad A, Barsness GW. Long-term outcomes in survivors of early ventricular arrhythmias after acute ST-elevation and non-ST-elevation myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol. 2016;117(5):709-713. https://doi.org/10.1016/j.amjcard.2015.12.002
10. Masuda M, Nakatani D, Hikoso S, Suna S, Usami M, Matsumoto S, et al. Clinical Impact of Ventricular Tachycardia and/or Fibrillation During the Acute Phase of Acute Myocardial Infarction on In-Hospital and 5-Year Mortality Rates in the Percutaneous Coronary Intervention Era. Circ J. 2016;80(7):1539-1547. https://doi.org/10.1253/circj.CJ-16-0183
11. Mehta RH, Yu J, Piccini JP, Tcheng JE, Farkouh ME, Reiffel J et al. Prognostic significance of postprocedural sustained ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention (from the HORIZONS-AMI Trial). Am J Cardiol. 2012;109(6):805-812. https://doi.org/10.1016/j.amjcard.2011.10.043
12. Nalliah CJ, Zaman S, Narayan A, Sullivan J, Kovoor P. Coronary artery reperfusion for ST elevation myocardial infarction is associated with shorter cycle length ventricular tachycardia and fewer spontaneous arrhythmias. EP Eur. 2014;16(7):1053-1060. https://doi.org/10.1093/europace/eut307
13. Piccini J, Schulte O, Pieper K, Mehta R, White H, Van de Werf F et al. Antiarrhythmic drug therapy for sustained ventricular arrhythmias complicating acute myocardial infarction. Crit Care Med. 2011;39(1):78-83. https://doi.org/10.1097/CCM.0b013e3181fd6ad7
14. Piers S, Wijnmaalen A, Borleffs C, van Huls van Taxis C, Thijssen J, JB van R et al. Early reperfusion therapy affects inducibility, cycle length, and occurrence of ventricular tachycardia late after myocardial infarction. Circ Arrhythm Electrophysiol. 2011;4(2):195-201. https://doi.org/10.1161/CIRCEP.110.959213
15. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30(9):1038-1045. https://doi.org/10.1093/eurheartj/ehn579