Multiple sustained arrhythmias after STEMI: Case report
DOI:
https://doi.org/10.33448/rsd-v14i10.49739Keywords:
Myocardial Infarction, Cardiac Arrhythmias, Ventricular Tachycardia, Ventricular Fibrillation, Pacemaker Artificial.Abstract
Cardiac arrhythmias are the most common complication following acute myocardial infarction (AMI), particularly in cases with ST-segment elevation (STEMI). Although usually self-limited, sustained arrhythmias are associated with worse prognosis and higher in-hospital mortality. Objective: To report a case of multiple sustained arrhythmias — both ventricular and supraventricular — occurring late after STEMI. Methods: Case report of a 64-year-old male admitted with anteroseptal STEMI, who underwent primary percutaneous coronary intervention (PCI). Results: The patient developed sustained ventricular tachycardia, ventricular fibrillation, and paroxysmal supraventricular tachycardia refractory to conventional therapy, associated with QT interval prolongation. After bicameral pacemaker implantation, QT interval shortening and complete arrhythmic resolution were observed, leading to progressive clinical recovery and hospital discharge. Conclusion: Sustained post-infarction arrhythmias, although uncommon, require prompt recognition and intensive management due to their association with early mortality. The coexistence of ventricular and supraventricular arrhythmias underscores the need for continuous electrocardiographic monitoring and multidisciplinary care, especially in patients with left ventricular dysfunction and QT prolongation.
References
Al-Khatib, S. M., Granger, C. B., Huang, Y., Lee, K. L., Califf, R. M., Simoons, M. L., et al. (2002). Sustained ventricular arrhythmias among patients with acute coronary syndromes with no ST-segment elevation: Incidence, predictors, and outcomes. Circulation, 106(3), 309–312.
Zipes, D. P., Libby, P., Bonow, R. O., Mann, D. L., & Tomaselli, G. F. (Eds.). (2022). Braunwald: Tratado de doenças cardiovasculares (11ª ed., Vols. 1–2). GEN | Guanabara Koogan.
Cairns, J. A., Connolly, S. J., Roberts, R., & Gent, M. (1997). Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. The Lancet, 349(9053), 675–682.
Desanctis, R. W., Block, P., & Hutter, A. M. (1972). Tachyarrhythmias in myocardial infarction. Circulation, 45(3), 681–702.
Jatene, I. B., Ferreira, J. F. M., Drager, L. F., Franken, M., & Moretti, M. A. (Eds.). (2022). Tratado de cardiologia SOCESP (5ª ed.). Manole.
Frampton, J., Ortengren, A. R., & Zeitler, E. P. (2023). Arrhythmias after acute myocardial infarction. Yale Journal of Biology and Medicine, 96(1), 83–94.
Ganz, L. I., & Friedman, P. L. (1995). Supraventricular tachycardia. The New England Journal of Medicine, 332(3), 162–173.
Harkness, J. R., Morrow, D. A., Braunwald, E., Ren, F., Lopez-Sendon, J., Bode, C., et al. (2011). Myocardial ischemia and ventricular tachycardia on continuous electrocardiographic monitoring and risk of cardiovascular outcomes after non–ST-segment elevation acute coronary syndrome (from the MERLIN-TIMI 36 trial). American Journal of Cardiology, 108(10), 1373–1381.
Jons, C., Jacobsen, U. G., Joergensen, R. M., Olsen, N. T., Dixen, U., Johannessen, A., et al. (2011). The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction: A CARISMA substudy. Heart Rhythm, 8(3), 342–348.
Newby, K. H., Thompson, T., Stebbins, A., Topol, E. J., Califf, R. M., & Natale, A. (1998). Sustained ventricular arrhythmias in patients receiving thrombolytic therapy: Incidence and outcomes. Circulation, 98(23), 2567–2573.
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria.Editora da UFSM.
Podrid, P. J. (2024). Ventricular arrhythmias during acute myocardial infarction: Incidence, mechanisms, and clinical features. UpToDate. https://www.uptodate.com
Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta Paulista de Informática. 20(2), 5-6.
Spragg, D., & Kumar, K. (2024). Supraventricular arrhythmias after myocardial infarction. UpToDate. https://www.uptodate.com
Tran, H. V., Ash, A. S., Gore, J. M., Darling, C. E., Kiefe, C. I., & Goldberg, R. J. (2019). Twenty-five year trends (1986–2011) in hospital incidence and case-fatality rates of ventricular tachycardia and ventricular fibrillation complicating acute myocardial infarction. American Heart Journal, 208, 1–10.
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Copyright (c) 2025 Maria Fernanda Prevital Garcia, Luis Felipe Prevital Garcia, Luiz Guilherme Figueira Honório, Sabrina Neves Ribeiro, Vanessa Bernardo Nunes Lepre
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