https://doi.org/10.4081/monaldi.2025.3286
Cardiac arrhythmia following acute myocardial infarction: a retrospective analysis of 27,648 hospitalized patients in a tertiary heart hospital
Submitted: December 1, 2024
Accepted: January 31, 2025
Published: April 23, 2025
Accepted: January 31, 2025
Abstract Views: 9
PDF_EARLY VIEW: 6
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Arrhythmia frequently complicates acute myocardial infarction (AMI) and contributes to high morbidity and mortality. We aimed to investigate the prevalence, risk factors, and impact of cardiac arrhythmias in AMI patients at a tertiary heart hospital. This retrospective observational study included AMI patients who were admitted between January 1991 and May 2022. Patients’ data were analyzed and compared according to the absence or presence of cardiac arrhythmias post-AMI. We hypothesized that arrhythmias are associated with higher mortality following AMI. During the study, 27,648 patients were hospitalized with AMI, of whom 2118 (7.7%) developed arrhythmia. Patients who developed arrhythmia had a higher average age compared to those without arrhythmia (57.2 vs. 54.8 years, p=0.001), and a larger proportion were male compared to female patients (85.2% vs. 14.8%, p=0.001). Atrial fibrillation was observed in 383 patients (18.1%). Ventricular tachycardia was found in 461 (21.8%), and ventricular fibrillation occurred in 526 patients (24.8%). Complete heart block was developed in 286 (13.5%) patients, 1st-degree atrioventricular (AV) block in 36 (1.7%), 2nd-degree AV block in 138 (6.5%), left bundle branch block in 81 (3.8%), and right bundle branch block in 118 (5.6%). The rate of β-blocker use has increased in the arrhythmias group at discharge compared to the on-admission rate (55.7% vs. 32.5%). However, it remained sub-optimal. Arrhythmias were associated with longer hospital stays and five times higher hospital mortality than the non-arrhythmia group. Multivariable logistic regression analysis indicated that arrhythmia was associated with increased mortality risk three times following AMI (adjusted odds ratio 3.01; 95% confidence interval 2.42-3.75, p=0.001). Almost one-tenth of patients hospitalized with AMI in Qatar developed arrhythmia with variable outcomes; however, the in-hospital mortality remained high. Addressing the risk factors and optimizing the prevention and treatment of AMI and arrhythmias is crucial to improving clinical outcomes. This study may underestimate the incidence of arrhythmias post-AMI as it did not report all types.
Frampton J, Ortengren AR, Zeitler EP. Arrhythmias after acute myocardial infarction. Yale J Biol Med 2023;96:83-94.
Mueed A, Khatti S, Ashraf J, et al. Arrhythmia in acute myocardial infarction: a six-month retrospective analysis from the national institute of cardiovascular diseases. Cureus 2020;12:e11322.
Aufderheide TP. Arrhythmias associated with acute myocardial infarction and thrombolysis. Emerg Med Clin North Am 1998;16:583-600, viii.
Shah JA, Naz F, Kumar R, et al. Incidence of cardiac arrhythmias in acute myocardial infarction patients undergoing primary percutaneous coronary intervention and associated outcomes during the first 24 hours. Cureus 2021;13:e12599.
Ohlow MA, Geller JC, Richter S, et al. Incidence and predictors of ventricular arrhythmias after ST-segment elevation myocardial infarction. Am J Emerg Med 2012;30:580-6.
Sharma R, Chowdhary I, Sharma A. Arrhythmia and its risk factors post-myocardial infarction: a prospective study. J Acute Dis 2022;11:26-31.
Behar S, Reicher-Reiss H, Shechter M, et al. Frequency and prognostic significance of secondary ventricular fibrillation complicating acute myocardial infarction: SPRINT Study Group. Am J Cardiol 1993;7:152-6.
Benito B, Josephson ME. Ventricular tachycardia in coronary artery disease. Rev Esp Cardiol 2012;65:939-55.
Mehta RH, Starr AZ, Lopes RD, et al. Incidence of and outcomes associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention. JAMA 2009;301:1779-89.
Mehta LS, Beckie TM, DeVon HA, et al. Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation 2016;133:916-47.
Nepper-Christensen L, Lønborg J, Høfsten DE, et al. Clinical outcome following late reperfusion with percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2021;10:523-31.
Martinez-Navarro H, Zhou X, Bueno-Orovio A, Rodriguez B. Electrophysiological and anatomical factors determine arrhythmic risk in acute myocardial ischemia and its modulation by sodium current availability. Interface Focus 2021;11:20190124.
Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med 2001;345:1473-82.
Suryanarayana P, Garza HK, Klewer J, Hutchinson MD. Electrophysiologic considerations after sudden cardiac arrest. Curr Cardiol Rev 2018;14:102-8.
King GS, Goyal A, Grigorova Y, et al. Antiarrhythmic medications. Treasure Island (FL): StatPearls Publishing; 2023.
Zijlstra F, de Boer MJ, Hoorntje JC, et al. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med 1993;328:680-4.
Weaver WD, Simes RJ, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA 1997;278:2093-8.
Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet 2003;361:13-20.
Hindricks G, Lenarczyk R, Kalarus Z, et al. Prevention of sudden cardiac death by the implantable cardioverter-defibrillator. Pol Arch Intern Med 2018;128:764-70.
Tran HV, Lessard D, Tisminetzky MS, et al.Trends in length of hospital stay and the impact on prognosis of early discharge after a first uncomplicated acute myocardial infarction. Am J Cardiol 2018;121:397-402.
Salam AM, Salim I, Kaddoura R, et al. Hypertension in Middle Eastern Arab and South Asian patients with atrial fibrillation: from a 20-year hospital registry in Qatar (1990-2010). Heart Views 2022;22:256-63.
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation 2018;138:e618-51.
Abid AR, El-Menyar A, Singh R, et al. Patterns and outcomes of obesity using body mass index in patients hospitalized with acute cardiovascular disorders: a retrospective analysis of 7284 patients in a Middle Eastern country. J Clin Med 2023;12:7263.
El-Menyar AA, Albinali HA, Bener A, et al. Prevalence and impact of diabetes mellitus in patients with acute myocardial infarction: a 10-year experience. Angiology 2009;60:683-8.
El-Menyar A, Al Habib KF, Zubaid M, et al. Utility of shock index in 24,636 patients presenting with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care 2020;9:546-56.
Villareal RP, Woodruff AL, Massumi A. Gender and cardiac arrhythmias. Tex Heart Inst J 2001;28:265-75.
Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271:840-4.
Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 2019;139:e56-528. Erratum in: Circulation 2020;141:e33.
January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. Circulation 2014;130:2071-104. Erratum in: Circulation 2014;130:e270-1.
Hedayatnia M, Asadi Z, Zare-Feyzabadi R, et al. Dyslipidemia and cardiovascular disease risk among the MASHAD study population. Lipids Health Dis 2020;19:42.
Yusuf S, Hawken S, Ounpuu S, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with MI in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937-52.
Mehreen T, Ishtiaq W, Rasheed G, et al. In-hospital mortality among critically ill patients with atrial fibrillation (AF) versus patients without AF. Cureus 2021;13:e18761.
Patel U, Desai R, Munshi R, et al. Burden of arrhythmias and associated in-hospital mortality in acute decompensated diabetes mellitus. Proc (Bayl Univ Med Cent) 2021;34:545-9.
De la Fuente-Martínez J, Infante-Valenzuela A, Martínez-Roque D, et al. Impact of arrhythmia in-hospital mortality in acute ischemic stroke patients: a retrospective cohort study in northern Mexico. J Stroke Cerebrovasc Dis 31:106259.
Soliman EZ, Safford MM, Muntner P, et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern Med 2014;174:107-14. Erratum in: JAMA Intern Med 2014;174:308.
Koplan BA, Stevenson WG. Ventricular tachycardia and sudden cardiac death. Mayo Clin Proc 2009;84:289-97. Erratum in: Mayo Clin Proc 2009;84:483.
Shirafkan A, Mehrad M, Gholamrezanezhad A, Shirafkan A. Conduction disturbances in acute myocardial infarction: a clinical study and brief review of the literature. Hellenic J Cardiol 2009;50:179-84.
Li J, Li X, Dong S, et al. Clinical characteristics and value in early reperfusion therapy for new onset right bundle branch block in patients with acute myocardial infarction. Exp Ther Med 2018;15:2620-6.
Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005;111:2042-9.
Solomon SD, Anavekar N, Skali H, et al. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 2005;112:3738-44.
Hartman MHT, Eppinga RN, Vlaar PJJ, et al. The contemporary value of peak creatine kinase-MB after ST-segment elevation myocardial infarction above other clinical and angiographic characteristics in predicting infarct size, left ventricular ejection fraction, and mortality. Clin Cardiol 2017;40:322-8.
Arakawa N, Nakamura M, Aoki H, Hiramori K. Relationship between plasma level of brain natriuretic peptide and myocardial infarct size. Cardiology 1994;85:334-40.
Nagaya N, Nishikimi T, Goto Y, et al. Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular remodeling after acute myocardial infarction. Am Heart J 1998;135:21-8.
Richards AM, Nicholls MG, Yandle TG, et al. Neuroendocrine prediction of left ventricular function and heart failure after acute myocardial infarction. The Christchurch Cardioendocrine Research Group. Heart 1999;81:114-20.
Richards AM, Nicholls MG, Yandle TG, et al. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction. Circulation 1998;97:1921-9.
Ahmad M, Mehta P, Reddivari AKR, et al. Percutaneous coronary intervention. Treasure Island (FL): StatPearls Publishing; 2023.
Montalescot G, Andersen HR, Antoniucci D, et al. Recommendations on percutaneous coronary intervention for the reperfusion of acute ST elevation myocardial infarction. Heart 2004;90:e37.
Joo SJ. Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it. Acute Crit Care 2023;38:251-60.
Farzam K, Jan A. Beta blockers. Treasure Island (FL): StatPearls Publishing; 2023
Gheorghiade M, Goldstein S. β-blockers in the post–myocardial infarction patient. Circulation 2002;106:394-8.
Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of individual data from 100,000 patients in randomized trials. ACE Inhibitor Myocardial Infarction Collaborative Group. Circulation 1998;97:2202-12.
Kober L, Torp-Pedersen C, Carlsen JE. A clinical trial of ACE inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandopril cardiac evaluation (TRACE) study group. N Eng J Med 1995;333:1670-6
Cleland JG, Erhardt L, Murray G, Hall AS, Ball SG. Effect of Ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure. Eur Heart J 1997;18:41-51.
Biswajit Das. Prevention and management of arrhythmias in acute myocardial infarction. Int J Contemp Med Res 2016;3:1401-5.
Gorenek B, Lundqvist CB, Terradellas JB, et al. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Eur Heart J Acute Cardiovasc Care 2015;4:386.
Shah JA, Naz F, Kumar Ret al. Incidence of cardiac arrhythmias in acute myocardial infarction patients undergoing primary percutaneous coronary intervention and associated outcomes during the first 24 hours. Cureus 2021;13:e12599.
Smith GL, Masoudi FA, Shlipak MG, et al. Renal impairment predicts long-term mortality risk after acute myocardial infarction. J Am Soc Nephrol 2008;19:141-50.
Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J 2009;30:1038-45.
Travin MI, Feng D, Taub CC. Novel Imaging approaches for predicting arrhythmic risk. Circ Cardiovasc Imaging 2015;8:e003019.
Ethics Approval
Ethical approval was obtained from the Institutional Review Board of Hamad Medical Corporation, Qatar (MRC#11355/11).How to Cite
Asaad, Nidal, Ayman El-Menyar, Rajvir Singh, Betsy Varughese, Shahul Hameed Khan, Hajar AlBinali, and Jassim Al Suwaidi. 2025. “Cardiac Arrhythmia Following Acute Myocardial Infarction: A Retrospective Analysis of 27,648 Hospitalized Patients in a Tertiary Heart Hospital”. Monaldi Archives for Chest Disease, April. https://doi.org/10.4081/monaldi.2025.3286.
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Carlo Lombardi, Marco Sbolli, Dario Cani, Garbriele Masini, Marco Metra, Pompilio Faggiano, Preoperative cardiac risks in noncardiac surgery: The role of coronary angiography , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
- Berardo Sarubbi, Giancarlo Scognamiglio, Flavia Fusco, Enrico Melillo, Michele D'Alto, Maria Giovanna Russo, A “long-standing†malpositioned pacing lead. Long-term follow-up after extraction , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Gaetano Gentile, Ester Meles, Claudio Carbone, Edoardo Cantù, Stefano Maggiolini, Unusual case of myocardial injury induced by Escherichia coli sepsis , Monaldi Archives for Chest Disease: Vol. 74 No. 1 (2010): Cardiac series
- Camillo Taglieri, Enrico Lombardo, Mauro Feola, Prevention of left ventricular remodeling after myocardial infarction: efficacy of physical training , Monaldi Archives for Chest Disease: Vol. 70 No. 2 (2008): Cardiac series
- Paola Gremigni, Cynical hostility and the metabolic syndrome: A case-control study , Monaldi Archives for Chest Disease: Vol. 66 No. 3 (2006): Cardiac series
- Enrico Vizzardi, Edoardo Sciatti, Ivano Bonadei, Natalia L. Pezzali, Carlo M. Lombardi, Marco Metra, Red cell distribution width and chronic heart failure: prognostic role beyond echocardiographic parameters , Monaldi Archives for Chest Disease: Vol. 84 No. 1-2 (2015): Cardiac series
- Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava, Revolving door respiratory patients: A rehabilitative perspective , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Riccardo Rovetta, Enrico Vizzardi, Antonio D’Aloia, Ivano Bonadei, Edoardo Sciatti, Marco Metra, An unusual case of myocardial infarction , Monaldi Archives for Chest Disease: Vol. 82 No. 2 (2014): Cardiac series
- Mahmood Shirzad, Abbasali Karimi, Seyed Hossein Ahmadi, Mehrab Marzban, Mokhtar Tazik, Hermineh Aramin, Predictors and Early Outcome of Prolonged Mechanical Ventilation in Contemporary Heart valve Surgery , Monaldi Archives for Chest Disease: Vol. 74 No. 1 (2010): Cardiac series
- Erick Chan, Francesco Giallauria, Carlo Vigorito, Neil A. Smart, Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis , Monaldi Archives for Chest Disease: Vol. 86 No. 1-2 (2016): Cardiac series
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
