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Association of repolarization abnormalities in acute coronary syndrome with early occurrence of ventricular arrhythmias and its management

Rajat Sharma

Background: Acute myocardial ischemia is associated with an increase in repolarization heterogeneity. This is associated with prolongation of the QT interval.1 There has been growing evidence of the early repolarization (ER) pattern in electrocardiogram (ECG) and associated increased incidence of ventricular arrhythmias. Increase in the QT interval following acute myocardial infarction is presumed to be associated with a significantly higher risk for sudden death2. Any specific therapeutic interventions during the early vulnerable phase to reduce SCD was also studied. Materials and methods :This single centre observational study was conducted from hospital admissions with ACS from March 2019- Feb 2020 . The objective of the study was to establish any association between ECG evidence of repolarization abnormalities in acute coronary syndrome and early in-hospital VAs episodes. Standard ECG criteria of repolarization abnormalities like prolonged QTc , slurred and notched R wave, T wave abnormalities, J point Statistical analysis: The odds ratio (OR), its standard error and 95% confidence interval are calculated according to Altman, 1991.Test of significance: the P-value is calculated according to Sheskin, 2004 (p. 542). Result and observation: The presence of repolarization abnormalities in subjects with ACS were associated with increased ventricular tachyarrhythmias during the early hospitalized period.Use of common anti-arrhythmic agents like Amiodarone is associated with higher VAs during early hospitalization period in subjects with ECG evidence of repolarization abnormalities with ACS and necessitates co-administration of Lidocaine/Mexiletine and discontinuation of Amiodarone therapy. Conclusion: Repolarization abnormalities are associated with increased early ventricular tachyarrhythmias following acute coronary syndrome. Mexiletine in conjunction with beta blocker therapy is associated with significantly lower VAs in subjects with underlying repolarization abnormalities during acute coronary syndrome.