ECG Interpretation for Bradycardia and Tachycardia Complicating ACS

Dr Ngai-Yin Chan (Hong Kong)


Bradycardia and tachycardia commonly occur in patients with ACS. Sinus bradycardia is frequency seen with inferior wall MI since RCA supplies the SA node in 60% of patients. It usually responds to intravenous atropine and in some patients, temporary cardiac pacing may be needed. High grade AVB occurs in 9.8% and 3.2% of patients with inferior MI and anterior MI, respectively. High grade AVB associated with inferior MI is located proximal to His bundle in 90% of patients while in anterior MI, the AVB is more often distal to His bundle and indicative of extensive ischaemia or infarction involving infra-nodal conduction system.


Wide-complex tachycardia in general, or in the setting of ACS, includes the differential diagnoses of ventricular tachycardia, supraventricular tachycardia with aberrancy and supraventricular arrhythmias with pre-excitation. Brugada algorithm is a well-known and widely used tool for ECG diagnosis. The recently introduced Vereckei algorithm may also be useful.



Long-term Prevention After an ACS Event

Dr Marc S. Sabatine (USA)


A recent ACS event provides an opportunity to improve secondary prevention strategies to reduce the risk of recurrent cardiovascular events, including individualising existing treatments through optimised pharmacological treatment.


DAPT combining aspirin and a P2Y12 inhibitor consistently reduces recurrent MACE in patients after ACS. Particularly, more potent third-generation P2Y12 inhibitors (e.g. ticagrelor or prasugrel) could significantly reduce MACE compared with clopidogrel. Extended DAPT should be considered in patients with a previous MI who are at high ischaemic risk and low bleeding risk. Dr Sabatine shared the latest data on how stopping aspirin 1–3 months after PCI while continuing with P2Y12 inhibitor monotherapy reduces bleeding risk when compared with a traditional DAPT (aspirin and a P2Y12 inhibitor). This strategy does not appear to increase the risk of MACE.


ACS in Action CME Webinar: Connecting with The Experts

ACS in Action CME Webinar: Connecting with The Experts

9 Nov 2020

The third ACS in Action CME Webinar was held on 9 Nov 2020. At this meeting, two presentations on ECG diagnosis and the latest Long-term Prevention After an ACS Event were given by esteemed local and international faculty. 

Duration: 50 minutes