TREATMENTS AND OUTCOMES OF CARDIAC ARRHYTHMIAS AFTER MYOCARDIAL INFARCTION: A PROSPECTIVE, FOLLOW UP STUDY IN A TERTIARY- CARE HOSPITAL
Keywords:Acute myocardial infarction, arrhythmias, India
Purpose: Cardiac arrhythmias after acute myocardial infarction (AMI) are associated with significant mortality and morbidity. There is little epidemiological data from India on patients developing cardiac arrhythmias as a complication of AMI. We recorded the patterns, treatments and predictors of post- AMI arrhythmias in the hospital. We also determined the outcomes at six months and assessed the predictors of mortality using multivariate logistic regression.
Results: We recruited 202 AMI patients, of whom 102 (50.5%) developed arrhythmia. The commonest arrhythmias were blocks (59, 57.8%) ventricular arrhythmias (31, 30.4%) and atrial arrhythmias (17, 16.7%). Older age (OR 1.07, 95% CI 1.04, 1.10, p<0.0001) and increased heart rate (OR 1.02, 95% CI 1.01, 1.04, p=0.005) were predictors of arrhythmias. Of 102 patients with arrhythmia, 92 (90.2%) received specific treatments and 10 (9.8%) were conservatively managed. Beta blockers were used in 69 (67.6%) patients followed by amiodarone (22, 21.6%) and calcium channel blockers (21, 20.6%). Among those with arrhythmias, 14 (13.7%) died at six months. A lower ejection fraction at presentation (OR 0.86, 95% CI 0.78, 0.95, p=0.003) was a significant predictor of mortality.
Conclusion: Older age and increased heart rate were significant predictors of arrhythmias and a lower ejection fraction was a predictor of mortality. A larger, multi- centre study is required to understand the epidemiology of the disease in India and to assess the predictors and outcomes of post- AMI arrhythmias. This will help in better management of patients in the post infarction period and to improve outcomes.
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