Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization

Winkler, Catherine; Funk, Marjorie; Schindler, Daniel; Zègre‐Hemsey, Jessica; Lampert, Rachel; Drew, Barbara J.

doi:10.1016/j.hrtlng.2013.07.010

Cited by 29 publications

(23 citation statements)

References 25 publications

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“…130 Nonetheless, because ventricular arrhythmias are known to occur Patients with Class I indications for arrhythmia monitoring who need to be transported off the unit should have continuous electrocardiographic monitoring via a portable monitor-defibrillator/pacemaker with a healthcare provider skilled in use of the equipment and in electrocardiographic interpretation.…”

Section: Early Phase Of Acs (<24 Hours)mentioning

confidence: 99%

“…Despite the recommendation of the ACC/ AHA guidelines for revascularization in these patients, nearly 20% of patients with non-STsegment elevation ACS and either 3vessel disease or left main disease identified with coronary angiography during hospital ization, who are known to benefit from revasculariza tion, were managed medically. 161 During the first 24 hours of admission for patients with ACS, of whom 73% did not undergo PCI, Winkler et al 130 found that potentially lifethreatening arrhythmias occurred rare ly: <1% developed asystole, TdP, or VF, and only 1% had sustained VT. In this sample, 8.63% were diag nosed with STEMI, 26.62% with NSTEMI, and 64.75% with unstable angina.…”

Section: After MI Without Reperfusion or Revascularizationmentioning

confidence: 99%

See 1 more Smart Citation

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

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198

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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Section: Early Phase Of Acs (<24 Hours)mentioning

confidence: 99%

Section: After MI Without Reperfusion or Revascularizationmentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

Self Cite

198

214

View full text Add to dashboard Cite

show abstract

“…Recently, Winkler and colleagues 8 studied 278 patients diagnosed with ACS to determine the potential benefits of ST-segment monitoring in the ED; they found the incidence of ventricular arrhythmias (premature ventricular contractions, nonsustained ventricular tachycardia, and malignant arrhythmias) over the first 24 hours of hospitalization to be lower than studies conducted before the reperfusion era in the late 1980s.…”

Section: Arrhythmia Monitoring In the Emergency Departmentmentioning

confidence: 99%

Cardiac Monitoring in the Emergency Department

Zègre‐Hemsey

Garvey

Carey

2016

Critical Care Nursing Clinics of North America

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“…22 Higher rates of asystole or EMD have been reported in STEMI. 23 Rates of complete heart block have been previously reported as high as 2% to 5%, 13–17 and this is in part due to inclusion of STEMI patients.…”

Section: Discussionmentioning

confidence: 91%

High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non–ST-segment elevation myocardial infarction

Pokorney

Radder

Schulte

et al. 2016

American Heart Journal

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Background Non–ST-segment myocardial infarction (NSTEMI) can be complicated by high-degree atrioventricular (AV) block, asystole, or electromechanical dissociation (EMD), but these events are not well characterized in the contemporary era. This analysis assesses the incidence of and factors associated with these dysrhythmias in acute NSTEMIs. Methods Patients with NSTEMI in the EARLY ACS, PLATO, and TRACER trials were included in the pooled cohort (N = 29,677). Logistic regression was used to identify factors associated with in-hospital high-degree AV block and asystole or EMD, and Kaplan-Meier methods were used to assess mortality. Results High-degree AV block occurred in 112 (0.4%) patients, asystole in 157 (0.5%), and EMD in 38 (0.1%). Pacemakers were inserted in 241 patients (0.8%) during the index hospitalization: 30 (12%) for AV block. Among patients with high-degree AV block, we observed more frequent right coronary artery lesions (47% vs 29%). Age, diabetes, lower heart rate, and lower blood pressure were associated with high-degree AV block. Higher Killip class, ST-segment depression, prior myocardial infarction, and peripheral vascular disease were most strongly associated with asystole or EMD. Ten-day unadjusted survival was 90% for patients with high-degree AV block and 43% for those with asystole or EMD. Conclusions Although high-degree AV block, asystole, and EMD were infrequent complications of NSTEMI, they were associated with substantial short-term mortality. Only 1 in 8 pacemakers placed in NSTEMI patients during the acute hospitalization was for high-degree AV block.

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Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization

Cited by 29 publications

References 25 publications

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Cardiac Monitoring in the Emergency Department

High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non–ST-segment elevation myocardial infarction

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