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Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA)

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  • Zbigniew Kalarus
  • Jesper Hastrup Svendsen
  • Davide Capodanno
  • Gheorghe-Andrei Dan
  • Elia De Maria
  • Bulent Gorenek
  • Ewa Jędrzejczyk-Patej
  • Michał Mazurek
  • Tomasz Podolecki
  • Christian Sticherling
  • Jacob Tfelt-Hansen
  • Vassil Traykov
  • Gregory Y H Lip
  • Laurent Fauchier
  • Giuseppe Boriani
  • Jacques Mansourati
  • Carina Blomström-Lundqvist
  • Georges H Mairesse
  • Andrea Rubboli
  • Thomas Deneke
  • Nikolaos Dagres
  • Torkel Steen
  • Ingo Ahrens
  • Vijay Kunadian
  • Sergio Berti
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Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.

Original languageEnglish
JournalEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
Issue number10
Pages (from-to)1603-1604
Number of pages2
Publication statusPublished - 1 Oct 2019

ID: 59170612