Arrhythmia complications in acute coronary syndrome:Focused on tachyarrhythmias

Arrhythmias may occur as complications in acute coronary syndrome (ACS) patients. It includes tachyarrhythmia, whichmay be asymptomatic or symptomatic. At least around 75% of myocardial infarction patients develop arrhythmia during theperi-infarction period. Pathophysiology pathways differ in each type of arrhythmias. . It also contributes to different treatmentmodalities. Arrhythmogenesis in ACS patients includes various factors: electrophysiological changes, metabolic changes, increasedsympathetic activity, vagal stimulation, reduced left ventricular ejection fraction (LVEF), and scar formation. Myocardial reperfusionalso may result in complex electrophysiological changes, depending on previous ischemia duration. Ventricular arrhythmia is morecommon with increased ischemia duration. At present, the anti-arrhythmic prophylactic management strategy has mostly beenabandoned. Although the primary therapy for arrhythmias is anti-arrhythmic drugs (AADs), especially amiodarone and sodiumchannel inhibitors, their utilization now has declined, since the emergence of clinical evidence with inconclusive results in the useof these AADs. Besides, therapies for ACS and their arrhythmic management are increasingly based on invasive approaches. Sometachyarrhythmias are malignant and may increase death risk, which requires immediate treatment, while some are benign and donot alter the outcome of patients. Understanding the mechanism and adequate treatment of these tachyarrhythmias is essential inreducing mortality in ACS patients during the acute phase and follow-up.

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