Choice of Antiarrythmics Used in Different Arrhythmias Encountered in Patients Undergoing PTCA and Clinical Outcome: A Retrospective Observational Study

Abstract

Introduction: Percutaneous Transluminal Coronary Angioplasty (PTCA), is a minimally invasive procedure that opens blocked coronary arteries to improve blood flow to the heart muscle. It is indicated in angina patients unresponsive to maximal medical therapy and in ST elevated Myocardial Infarction (MI). A variety of arrhythmias and conduction disturbances can occur during and after Percutaneous Coronary Interventions (PCI), which can be risk factors for increased morbidity and mortality. Aim: To evaluate the choice of antiarrhythmics use in different arrhythmias encountered in patients undergoing PTCA and to assess the outcome. Materials and Methods: This retrospective observational study was conducted by analysing the data of 139 patients aged between 40 to 70 years who underwent PTCA in the year 2023. The study was carried out over eight months from January 2023 to August 2023 at the Cardiology Department of Max Hospital, Dehradun, Uttarakhand, India, located in Jakhan. All patients who underwent PTCA at Max Hospital, Dehradun (including stable and unstable angina patients not responding to medical therapy and Myocardial infarction cases), were included in the study. The sample size consisted of 139 patients aged 40 to 70 years who underwent PTCA. Age and gender ratios were considered as demographic factors. Computer records were reviewed for data collection. Additionally, the attending cardiologist was consulted for observations and the treatment plan followed. The outcomes were assessed at admission, after 10 days, and one and a half months for all drugs. The collected data results were analysed in terms of percentage and mean. Results: In the present study, the most common arrhythmias were ventricular premature complexes, occurring in all patients who underwent coronary angioplasty. The second most common arrhythmia was atrial fibrillation, present in 111 (80%) cases. The remainder consisted of atrial flutter 7 (5%), atrial tachycardia 1 (1%), Ventricular tachycardia 7 (5%), and ventricular fibrillation 0.6 (1%), as well as bradyarrhythmia/conduction defects in 69 (50%) cases. Drugs such as Amiodarone, Mexiletine, Lidocaine, Sotalol/Metoprolol, Flecainide, magnesium supplements, and Atropine were used based on the type of arrhythmias. The incidence of complications decreased at admission, after 10 days, one and half month, and the mortality rate decreased after the administration of all the drugs in the present study. Quality of life showed improvement. Conclusion: The most common arrhythmias occurring after PTCA were reperfusion arrhythmias, which were mostly selflimiting and resolved without treatment. Amiodarone was the most commonly used drug for both atrial and ventricular arrhythmias. Mexiletine was used for Ventricular Tachycardia, Flecainide for supraventricular arrhythmias, and Lidocaine for ventricular tachycardia not responsive to Cordarone. β-blockers were well-tolerated drugs used concomitantly with other antiarrhythmic drugs. The use of antiarrhythmic reduced morbidity and mortality after PTCA and improved the quality of life score.