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.
Key Words: Acute coronary syndrome; arrhythmia; myocardial infarction; tachycardia