Related Experiment Video
Updated: Dec 23, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Burden of Arrhythmias in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Saraschandra Vallabhajosyula1, Sri Harsha Patlolla2, Dhiran Verghese3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota.
Insights
Cardiac arrhythmias, including atrial fibrillation and ventricular tachycardia, are common in acute myocardial infarction with cardiogenic shock (AMI-CS). These arrhythmias indicate higher illness severity and lead to increased hospital resource utilization.
Area of Science:
- Cardiology
- Internal Medicine
- Critical Care Medicine
Background:
- Limited data exist on the prevalence and impact of arrhythmias in patients experiencing acute myocardial infarction with cardiogenic shock (AMI-CS).
- Understanding these arrhythmias is crucial for managing this high-risk patient population.
Purpose of the Study:
- To investigate the temporal trends, predictors, and outcomes of arrhythmias in a large AMI-CS population.
- To analyze in-hospital mortality and resource utilization in AMI-CS patients with and without arrhythmias.
Main Methods:
- A 17-year retrospective analysis of the National Inpatient Sample database (2000-2016) was conducted.
- Data from 420,319 admissions for AMI-CS were analyzed, excluding those with concomitant cardiac surgery.
- Common arrhythmias identified included atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, and atrioventricular blocks.
Main Results:
- Arrhythmias were present in 51% of AMI-CS admissions, with atrial fibrillation (45%), ventricular tachycardia (35%), and ventricular fibrillation (30%) being most common.
- Patients with arrhythmias were more likely to be male, white, have ST-segment elevation AMI-CS, and present with cardiac arrest and acute organ failure.
- While unadjusted mortality was slightly higher in the arrhythmia group, adjusted mortality showed no significant difference. However, patients with arrhythmias experienced longer hospital stays and higher hospitalization costs.
Conclusions:
- Cardiac arrhythmias in AMI-CS are associated with increased illness severity and significantly greater healthcare resource utilization.
- Predictors of mortality in the arrhythmia cohort include older age, female sex, non-white race, higher comorbidity, acute organ failure, and cardiac arrest.
- Further research may focus on targeted interventions to mitigate the impact of arrhythmias in AMI-CS.
Abstract:
There are limited data on arrhythmias in acute myocardial infarction with cardiogenic shock (AMI-CS). Using a 17-year AMI-CS population from the National Inpatient Sample, we identified common arrhythmias - atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, and atrioventricular blocks (AVB). Admissions with concomitant cardiac surgery were excluded. Outcomes of interest included temporal trends, predictors, in-hospital mortality, and resource utilization in cohorts with and without arrhythmias. Of the 420,319 admissions with AMI-CS during 2000 to 2016, arrhythmias were noted in 213,718 (51%). AF (45%), ventricular tachycardia (35%) and ventricular fibrillation (30%) were the most common arrhythmias. Compared with those without, the cohort w`ith arrhythmias was more often male, of white race, with ST-segment elevation AMI-CS presentation, and had higher rates of cardiac arrest and acute organ failure (all p <0.001). Temporal trends of prevalence revealed a stable trend of atrial and ventricular arrhythmias and declining trend in AVB. The cohort with arrhythmias had higher unadjusted (42% vs 41%; odds ratio [OR] 1.03 [95% confidence interval 1.02 to 1.05]; p <0.001), but not adjusted (OR 1.01 [95% CI 0.99 to 1.03]; p = 0.22) in-hospital mortality compared with those without. The cohort with arrhythmias had longer hospital stay (9 ± 10 vs 7 ± 9 days; p <0.001) and higher hospitalization costs ($124,000 ± 146,000 vs $91,000 ± 115,000; p <0.001). In the cohort with arrhythmias, older age, female sex, non-white race, higher co-morbidity, presence of acute organ failure, and cardiac arrest, predicted higher in-hospital mortality. In conclusion, cardiac arrhythmias in AMI-CS are a marker of higher illness severity and are associated with greater resource utilization.
Related Concept Videos
01:28Mechanism of Cardiac Arrhythmias
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:25Dysrhythmias VI: Management of Dysrhythmias
01:28Acute Coronary Syndrome IV: Interprofessional Care