TITLE:
Study of Bradyarrhythmias in Acute Myocardial Infarction
AUTHORS:
Samir Rafla, Sherif Wagdy Ayad, Mohamed Sanhoury
KEYWORDS:
Acute Myocardial Infarction, Complete Heart Block, Temporary Pacemakers, Bradyarrhythmias, Atropine
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.12 No.1,
January
26,
2022
ABSTRACT: 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 bradyarrhythmiasafter acute myocardial infarction, the study period was fiveyears. 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 in40, sick sinus syndrome in10, junctional rhythm in10, second-degree blockin10, complete heart block in24. We divided patients with sinus bradycardia into a stable group and an unstablegroup. 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 wasfound 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%. Theprognostic factors of CHB were defined. Techniques of introduction of thelead 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.