A clinical study of arrhythmias associated with acute myocardial infarction and thrombolysis


  • Mayuri A. Mhatre Department of Emergency Medicine, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
  • Freston M. Sirur Department of Emergency Medicine, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
  • Deepali R. Rajpal Department of Emergency Medicine, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
  • Manhar R. Shah Department of Emergency Medicine, D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India




Acute myocardial Infarction, Arrhythmias


Background: Arrhythmias are a common occurrence in ACS. This study was undertaken to analyze the incidence, frequency and type of arrhythmias in relation to the site of infarction to aid in timely intervention to modify the outcome in MI and to study the significance of Reperfusion arrhythmias.

Methods: 100 patients were evaluated. ECG and cardiac enzymes were studied. Arrhythmias complicating AMI in terms of their incidence, timing, severity, type, relation, reperfusion and results were studied.

Results: Of the 100 cases, 74% were males and 26% females of which incidence being common between 4th to 7th decades of life. AMI was common in patients with Diabetes and Hypertension (23% each). Incidence of AWMI (58%) is higher than IWMI (40%). Out of all arrhythmias, Ventricular Tachycardia was seen in 24% cases with 50% mortality and preponderance to Antero Lateral Myocardial Infarction. Sinus Tachycardia was seen in 23% of cases with preponderance to Antero Lateral Myocardial Infarction and persistence of Sinus Tachycardia was a prognostic sign, mortality being 22%. Complete Heart Block and Sinus Bradycardia were seen with IWMI, incidence being 53.8% and 100% respectively. Bundle Branch Block was common in AWMI (31%) than IWMI (10%). Among 64 thrombo-lysed cases, 21 had Reperfusion Arrhythmias without any mortality, whereas remaining 43 without Reperfusion Arrhythmias had mortality of 18.6%.

Conclusions: According to the study, Tachy-arrhythmias are common with Anterior Wall Myocardial Infarction and Brady-arrhythmias in Inferior Wall Myocardial Infarction. Reperfusion Arrhythmias are a benign phenomenon and good indicator of successful reperfusion.


Perron AD, Sweeney T. Arrhythmic complications of acute coronary syndromes. Emerg Med Clin N Am. 2005;23:1065-82.

Majumder AA, Malik A, Zafar A. Conduction disturbances in acute myocardial infarction: incidence, site-wise relationship and the influence on in-hospital prognosis. Bangladesh Med Res Counc Bull. 1996;22(2):74-80.

Martin TC, Longhuyzen VH, Bennett B, Peterson S, Beazer C, Thomas CV. The age-specific incidence of admission to the intensive care unit for acute myocardial infarction in Antigua and Barbuda. West Indian Med J. 2007;56(4):326-9.

Berger JS, Brown DL. Gender-age interaction in early mortality following primary angioplasty for acute myocardial infarction. Am J Cardiol. 2006;198(9):1140-3.

Trappolini M, Chillotti FM, Rinaldi R, Trappolini F, Coclite D, Napoletano AM et al. Sex differences in incidence of mortality after acute myocardial infarction. Ital Heart J Suppl. 2002;3(7):759-66.

Simon T, Mary-Krause M, Cambou JP, Hanania G, Guéret P, Lablanche JM et al. Impact of age and gender on in-hospital and late mortality after acute myocardial infarction: increased early risk in younger women: results from the French nation- wide USIC registries. Eur Heart J. 2006;27(11):1282-8.

Rosengren A, Thelle DS, Köster M, Rosén M. Changing sex ratio in acute coronary heart disease: data from Swedish national registers 1984-99. J Intern Med. 2003;253(3):301-10.

Rosengren A, Wallentin L, Gitt KA, Behar S, Battler A, Hasdai D. Sex, age, and clinical presentation of acute coronary syndromes. Eur Heart J. 2004;25(8):663-70.

Ivanusa M, Milicić D, Bozikov J, Ivanusa Z. Risk factors as prognostic factors of hospital mortality in patients with acute myocardial infarction. Acta Med Croatica. 2007;61(3):307-13.

Svensson AM, Dellborg M, Abrahamsson P, Karlsson T, Herlitz J, Duval SJ et al. The influence of a history of diabetes on treatment and outcome in acute myocardial infarction, during two time periods and in two different countries. Int J Cardiol. 2007;119(3):319-25.

Kokubo Y, Kamide K, Okamura T, Watanabe M, Higashiyama A, Kawanishi K, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease in a Japanese urban cohort: the Suita study. Hypertension. 2008;52(4):652-9.

Goldstein JA, Lee DT, Pica MC, Dixon SR, O'Neill WW. Patterns of coronary compromise leading to bradyarrhythmias and hypotension in inferior myocardial infarction. Coron Artery Dis. 2005;16(5):265-74.

Swart G, Brady WJ, DeBehnke DJ, MA OJ, Aufderheide TP. Acute myocardial infarction complicated by hemodynamically unstable bradyarrhythmia: prehospital and ED treatment with atropine. Am J Emerg Med. 1999;17(7):647-52.

Malla RR, Sayami A. In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction. JNMA J Nepal Med Assoc. 2007;46(167):99-102.

Crimm A, Severance HW, Coffey K, McKinnis R, Wagner GS, Califf RM. Prognostic significance of isolated sinus tachycardia during first three days of acute myocardial infarction. Am J Med. 1984;76(6):983-8.

Novaro GM, Asher CR, Bhatt DL, Moliterno DJ, Harrington RA, Lincoff AM, et al. Meta-analysis comparing reported frequency of atrial fibrillation after acute coronary syndromes in Asians versus whites. Am J Cardiol. 2008;15;101(4):506-9.

Asanin M, Perunicic J, Mrdovic I, Matic M, Vujisic-Tesic B, Arandjelovic A et al. Significance of recurrences of new atrial fibrillation in acute myocardial infarction. Int J Cardiol. 2006;109(2):235-40.

Pizzetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, Maggioni AP et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart 2001;86(5):527-32.

Ben Ameur Y, Mghaieth F, Ouchallal K, Hmem M, Te rras M, Longo S et al. Prognostic significance of second and third degree atrioventricular block in acute inferior wall myocardial infarction. Ann Cardiol Angeiol. 2003;52(1):30-3.

Rathore SS, Gersh BJ, Berger PB, Weinfurt KP, Oetgen WJ, Schulman KA et al. Acute myocardial infarction complicated by heart block in the elderly: prevalence and outcomes. Am Heart J. 2001;141(1):47-54.

García C, Abadal CA, Flores SJ, Marcos TH, Ruiz CA, Tudela VV. Duration of complete atrioventricular block complicating inferior wall infarction treated with fibrinolysis. Rev Esp Cardiol. 2005;58(1):20-6.

Spencer FA, Jabbour S, Lessard D, Yarzebski J, Ravid S, Zaleskas V, et al. Two- decade-long trends (1975-1997) in the incidence, hospitalization, and long-term death rates associated with complete heart block complicating acute myocardial infarction: a community-wide perspective. Am Heart J. 2003;145(3):500-7.

Moreno MA, Tomás GJ, Alberola GA, Hernández MJ, Mulero R. Prognostic significance of advanced atrioventricular block in patients with acute myocardial infarction. Med Clin. 2000;114(9):321-5.

Meine TJ, Al-Khatib SM, Alexander JH, Granger CB, White HD, Kilaru R et al. Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J. 2005;149(4):670-4.

Mavrić Z, Zaputović L, Matana A, Kucić J, Roje J, Marinović D et al. Prognostic significance of complete atrioventricular block in patients with acute inferior myocardial infarction with and without right ventricular involvement. Am Heart J. 1990;119(4):823-8.

Wong CK, Stewart RA, Gao W, French JK, Raffel C, White HD. Prognostic differences between different types of bundle branch block during the early phase of acute myocardial infarction: insights from the Hirulog and Early Reperfusion or Occlusion (HERO)-2 trial. Eur Heart J. 2006;27(1):21-8.

Wong CK, Gao W, Stewart RA, van Pelt N, French JK, Aylward PE et al. Risk stratification of patients with acute anterior myocardial infarction and right bundle-branch block: importance of QRS duration and early ST-segment resolution after fibrinolytic therapy. Circulation. 2006;114(8):783-9.

Elizari MV, Acunzo RS, Ferreiro M. Hemiblocks revisited. Circulation. 2007;115(9):1154-63.

Horvat D, Grman-Fanfani A, Kupres V, Grman J, Sporcić-Jelić V. Frequency of ventricular premature beats and ventricular tachycardia in STEMI treated with fibrinolytics. Coll Antropol. 2008;32(1):99-102.

Gibson CM, Pride YB, Buros JL, Lord E, Shui A, Murphy SA et al. Association of impaired thrombolysis in myocardial infarction myocardial perfusion grade with ventricular tachycardia and ventricular fibrillation following fibrinolytic therapy for ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2008;51(5):546-51.

Al-Khatib SM, Stebbins AL, Califf RM, Lee KL, Granger CB, White HD et al. Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial. Am Heart J. 2003;145(3):515-21.

Gao RL. Reperfusion arrhythmias in acute myocardial infarction. Clin Med J. 1993;106(7):514-7.

Osmancik PP, Stros P, Herman D. In hospital arrhythmias in patients with acute myocardial infarction the relation to the reperfusion strategy and their prognostic impact. Acute Card Care. 2008;10(1):15-25.

Ghuran AV, Cann AJ. Ischaemic heart disease presenting as arrhythmias. Br Med Bulletin. 2001;59:193-210.




How to Cite

Mhatre, M. A., Sirur, F. M., Rajpal, D. R., & Shah, M. R. (2016). A clinical study of arrhythmias associated with acute myocardial infarction and thrombolysis. International Journal of Research in Medical Sciences, 5(1), 335–343. https://doi.org/10.18203/2320-6012.ijrms20164574



Original Research Articles