Abstract:
Arrhythmias may occur as complications in acute coronary syndrome (ACS) patients. It includes tachyarrhythmia, which
may be asymptomatic or symptomatic. At least around 75% of myocardial infarction patients develop arrhythmia during the
peri-infarction period. Pathophysiology pathways differ in each type of arrhythmias. . It also contributes to different treatment
modalities. Arrhythmogenesis in ACS patients includes various factors: electrophysiological changes, metabolic changes, increased
sympathetic activity, vagal stimulation, reduced left ventricular ejection fraction (LVEF), and scar formation. Myocardial reperfusion
also may result in complex electrophysiological changes, depending on previous ischemia duration. Ventricular arrhythmia is more
common with increased ischemia duration. At present, the anti-arrhythmic prophylactic management strategy has mostly been
abandoned. Although the primary therapy for arrhythmias is anti-arrhythmic drugs (AADs), especially amiodarone and sodium
channel inhibitors, their utilization now has declined, since the emergence of clinical evidence with inconclusive results in the use
of these AADs. Besides, therapies for ACS and their arrhythmic management are increasingly based on invasive approaches. Some
tachyarrhythmias are malignant and may increase death risk, which requires immediate treatment, while some are benign and do
not alter the outcome of patients. Understanding the mechanism and adequate treatment of these tachyarrhythmias is essential in
reducing mortality in ACS patients during the acute phase and follow-up.
