TY - JOUR

T1 - Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization

T2 - 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)

AU - Kalarus, Zbigniew

AU - Svendsen, Jesper Hastrup

AU - Capodanno, Davide

AU - Dan, Gheorghe-Andrei

AU - De Maria, Elia

AU - Gorenek, Bulent

AU - Jędrzejczyk-Patej, Ewa

AU - Mazurek, Michał

AU - Podolecki, Tomasz

AU - Sticherling, Christian

AU - Tfelt-Hansen, Jacob

AU - Traykov, Vassil

AU - Lip, Gregory Y H

AU - Fauchier, Laurent

AU - Boriani, Giuseppe

AU - Mansourati, Jacques

AU - Blomström-Lundqvist, Carina

AU - Mairesse, Georges H

AU - Rubboli, Andrea

AU - Deneke, Thomas

AU - Dagres, Nikolaos

AU - Steen, Torkel

AU - Ahrens, Ingo

AU - Kunadian, Vijay

AU - Berti, Sergio

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

PY - 2019/10

Y1 - 2019/10

N2 - 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.

AB - 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.

U2 - 10.1093/europace/euz163

DO - 10.1093/europace/euz163

M3 - Journal article

C2 - 31353412

VL - 21

SP - 1603–1604p

JO - Europace

JF - Europace

SN - 1099-5129

IS - 10

ER -