News of cardiology and cardiac surgery

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)

Kalarus Z., Svendsen J.H., Capodanno D., Dan G.-A., De Maria E., Gorenek B., Jędrzejczyk-Patej Е., Mazurek M., Podolecki Т., Sticherling C., Tfelt-Hansen J., Traykov V., Lip G.Y.H.

Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias, particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of ventricular arrhythmias has declined in the hospital phase of acute coronary syndromes, mainly due to prompt revascularization and optimal medical therapy, still up to 6 % patients with acute coronary syndromes develop ventricular tachycardia and/or ventricular fibrillation within the first hours of acute coronary syndromes symptoms. Despite sustained ventricular arrhythmias being perceived predictors of worse in-hospital outcomes, specific associations between the type of ventricular arrhythmias, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation 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 atrial fibrillation, 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 atrial fibrillation 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 ventricular arrhythmias complicating AMI in relation to arrhythmia timing has been discussed.

Key words: ventricular tachycardia, ventricular fibrillation, atrial fibrillation, acute myocardial infarction, reperfusion.