Pattern of Arrhythmias in Acute Coronary Syndrome Patients Presenting at B. P. Koirala Institute of Health Sciences, Nepal

Abstract

BACKGROUND Acute Coronary Syndrome (ACS) is the leading cause of mortality and morbidity worldwide. Arrhythmias are a major contributor to morbidity and mortality in patients with ACS. Early arrhythmic events, particularly ventricular tachycardia (VT) and ventricular fibrillation (VF), frequently lead to sudden cardiac death if not promptly treated. Although these arrhythmias occur most commonly within the first 24 hours following ACS, late-onset arrhythmia can also develop, especially in patients with extensive infarcts or heart failure. The presence of arrhythmias often indicates more severe myocardial injury and is associated with a poorer long-term prognosis.

METHODS This was a prospective cross sectional observational study conducted at the department of Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, for a period of 3 months (2026 to March 2026). 70 consecutive cases of Acute Coronary Syndrome (ACS) were included in the study based on inclusion and exclusion criteria. Detailed clinical profiles, electrocardiographic changes, echocardiographic metrics, and serum cardiac biomarkers were systematically documented. Continuous cardiac monitoring was done in Coronary Care Unit (CCU) admission to capture all distinct arrhythmic presentations. Statistical data analysis was performed by SPSS 2020.

RESULTS The cohort showed a slight male predominance (51.42%), a median age of 65 years, and 78.6% of patients were over 60. Key risk factors included diabetes (45.71%), dyslipidemia (40.0%), smoking (38.57%), and hypertension (34.32%). ST-elevation myocardial infarction (STEMI) was the primary presentation (58.6%), most frequently affecting the anteroseptal wall (44.28%). 
The overall arrhythmia incidence was 75.7%. Ventricular premature contractions (VPCs) were most common (52.9%), followed by sinus tachycardia (25.7%). Complete (third-degree) atrioventricular block occurred in 7.1% of cases (requiring temporary pacing) and sustained ventricular tachycardia (VT) in 4.3% (requiring cardioversion). Regarding complications, 20% developed acute heart failure, 10% experienced cardiogenic shock, and 2.85% died from refractory VT.

CONCLUSIONS Arrhythmias complicate a vast majority of ACS presentations in this regional Nepalese setting and significantly contribute to in-hospital morbidity and mortality. Metabolic and lifestyle risks, particularly diabetes, dyslipidemia, and smoking are highly prevalent and underscore the need for enhanced risk stratification and vigilant continuous cardiac monitoring in resource-constrained cardiac units.