ECG-Guided Antiarrhythmic Therapy in Acute Coronary Syndrome: A Multidimensional Assessment of Biomarkers, Cardiac Function, and Quality of Life

Objective: To evaluate the impact of electrocardiogram (ECG)-guided antiarrhythmic strategy on serum biomarkers, cardiac function, and quality of life in patients with acute coronary syndrome (ACS) and arrhythmias. Methods: This prospective observational cohort enrolled 80 ACS patients with arrhythmias managed via a monitor-alert-response-titration pathway (observation group) during January-December 2024. Propensity score-matched controls (n = 80) received conventional experience-based antiarrhythmic therapy. Comparisons included in-hospital antiarrhythmic interventions, arrhythmia control, adverse events, and myocardial injury/stress biomarkers (NT-proBNP, hs-cTnI, hs-cTnT, hs-CRP) at T0 (baseline), T1 (2-day), and T2 (7-day). Cardiac function (LVEF, LVEDD, LVEDVI, E/e′) and patient-reported outcomes [Seattle Angina Questionnaire (SAQ), 6-minute walk test (6MWT)] were assessed at T0, T3 (1-month), and T4 (6-month). Major adverse cardiovascular events (MACE) were recorded over 6 months. Results: The observation group demonstrated higher β-blocker utilization, guideline adherence, and drug adjustment rates ( P < 0.05). Arrhythmia control was superior in the observation group at T2 (93.75% vs 82.50%, P < 0.05). More pronounced reductions in all biomarkers were observed in the observation group at T1 and T2 ( P < 0.05). Greater improvements in LVEF, LVEDD, LVEDVI, E/e′, SAQ scores, and 6MWT distance were sustained in the observation group at T3 and T4 ( P < 0.05). The 6-month MACE rate was lower in the observation group (13.75% vs 32.50%, P < 0.05). Conclusion: ECG-guided antiarrhythmic therapy improves pharmacotherapy quality and arrhythmia control, accelerating myocardial injury and stress attenuation. This strategy approach enhances cardiac recovery, reverse remodeling, functional capacity, and quality of life, ultimately reducing long-term cardiovascular risk. Keywords: acute coronary syndrome, ECG-guided antiarrhythmic therapy, cardiac function, biomarkers, quality of life