Atrial fibrillation acute myocardial infarction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Atrial dysfunction secondary to atrial ischemia and increased left atrial pressure as a consequence of it, explain pathogenesis of atrial fibrillation in the setting of acute myocardial infarction. Coronary Artery Surgery Study (CASS) reported that atrial fibrillation was found to be present in 0.6% patients with coronary artery disease (CAD). Another study reported an overall incidence of atrial fibrillation complicating myocardial infarction (MI) to be 16%. The management of new onset atrial fibrillation after myocardial infarction (MI) is important, because majority of the patients with hemodynamic compromise during atrial fibrillation is a result of rapid ventricular rate which increases myocardial oxygen demand, thereby exacerbating ongoing ischemia and possibly decreasing cardiac output.

Pathophysiology

The following are pathogenesis of atrial fibrillation in the setting of acute myocardial infarction:[1][2][3]

Epidemiology and Demographics

Clinical Trial Data

Treatment

The management of new onset atrial fibrillation after myocardial infarction (MI) is important, because majority of the patients with hemodynamic compromise during atrial fibrillation is a result of rapid ventricular rate which increases myocardial oxygen demand, thereby exacerbating ongoing ischemia and possibly decreasing cardiac output.

Hemodynamically Unstable

Hemodynamically Stable

Anticoagulation: New Onset Sustained Afib after MI

Prevention

Early statin therapy is indicated in ischemic heart disease, after coronary artery bypass surgery, and to reduce atrial fibrillation recurrences. However it is not recommended to prevent atrial fibrillation in patients with myocardial infarction (MI).[14]

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[15]

Acute Myocardial Infarction (DO NOT EDIT)[15]

Class I
"1. Direct-current cardioversion is recommended for patients with severe hemodynamic compromise or intractable ischemia, or when adequate rate control cannot be achieved with pharmacological agents in patients with acute myocardial infarction (MI) and atrial fibrillation. (Level of Evidence: C)"
"2. Intravenous administration of amiodarone is recommended to slow a rapid ventricular response to atrial fibrillation and improve LV function in patients with acute myocardial infarction (MI). (Level of Evidence: C)"
"3. Intravenous beta blockers and nondihydropyridine calcium antagonists are recommended to slow a rapid ventricular response to atrial fibrillation in patients with acute myocardial infarction (MI) who do not have LV dysfunction, bronchospasm, or AV block. (Level of Evidence: C)"
"4. For patients with atrial fibrillation and acute myocardial infarction (MI), administration of unfractionated heparin by either continuous intravenous infusion or intermittent subcutaneous injection is recommended in a dose sufficient to prolong the activated partial thromboplastin time to 1.5 to 2.0 times the control value, unless contraindications to anticoagulation exist. (Level of Evidence: C)"
Class III (Harm)
"1. The administration of class IC antiarrhythmic drugs is not recommended in patients with atrial fibrillation in the setting of acute myocardial infarction (MI). (Level of Evidence: C)"
Class IIa
"1. Intravenous administration of digitalis is reasonable to slow a rapid ventricular response and improve LV function in patients with acute myocardial infarction (MI) and atrial fibrillation associated with severe LV dysfunction and heart failure. (Level of Evidence: C)"

Sources

References

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  2. 2.0 2.1 Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM (1997) Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol 30 (2):406-13. PMID: 9247512
  3. Hod H, Lew AS, Keltai M, Cercek B, Geft IL, Shah PK, Ganz W (1987). "Early atrial fibrillation during evolving myocardial infarction: a consequence of impaired left atrial perfusion". Circulation. 75 (1): 146–50. PMID 3791600. Retrieved 2011-04-19. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 Cameron A, Schwartz MJ, Kronmal RA, Kosinski AS (1988). "Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry)". The American Journal of Cardiology. 61 (10): 714–7. PMID 3258467. Retrieved 2011-04-19. Unknown parameter |month= ignored (help)
  5. Goldberg RJ, Seeley D, Becker RC, Brady P, Chen ZY, Osganian V, Gore JM, Alpert JS, Dalen JE (1990). "Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective". American Heart Journal. 119 (5): 996–1001. PMID 2330889. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  6. JAMES TN (1961). "Myocardial infarction and atrial arrhythmias". Circulation. 24: 761–76. PMID 14451030. Retrieved 2011-04-18. Unknown parameter |month= ignored (help)
  7. Wong CK, White HD, Wilcox RG, Criger DA, Califf RM, Topol EJ, Ohman EM (2000). "New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience". American Heart Journal. 140 (6): 878–85. PMID 11099991. Retrieved 2011-04-18. Unknown parameter |month= ignored (help)
  8. Pizzetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, Maggioni AP, Santoro L, Tognoni G (2001). "Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data". Heart (British Cardiac Society). 86 (5): 527–32. PMC 1729969. PMID 11602545. Retrieved 2011-04-18. Unknown parameter |month= ignored (help)
  9. Pedersen OD, Bagger H, Køber L, Torp-Pedersen C (1999). "The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evalution". European Heart Journal. 20 (10): 748–54. PMID 10329066. Retrieved 2011-04-18. Unknown parameter |month= ignored (help)
  10. Al-Khatib SM, Pieper KS, Lee KL, Mahaffey KW, Hochman JS, Pepine CJ, Kopecky SL, Akkerhuis M, Stepinska J, Simoons ML, Topol EJ, Califf RM, Harrington RA (2001). "Atrial fibrillation and mortality among patients with acute coronary syndromes without ST-segment elevation: results from the PURSUIT trial". The American Journal of Cardiology. 88 (1): A7, 76–9. PMID 11423065. Retrieved 2011-04-18. Unknown parameter |month= ignored (help)
  11. Jabre P, Roger VL, Murad MH, Chamberlain AM, Prokop L, Adnet F, Jouven X (2011). "Mortality Associated With Atrial Fibrillation in Patients With Myocardial Infarction: A Systematic Review and Meta-Analysis". Circulation. doi:10.1161/CIRCULATIONAHA.110.986661. PMID 21464054. Retrieved 2011-04-18. Unknown parameter |month= ignored (help)
  12. Køber L, Bloch Thomsen PE, Møller M, Torp-Pedersen C, Carlsen J, Sandøe E, Egstrup K, Agner E, Videbaek J, Marchant B, Camm AJ (2000). "Effect of dofetilide in patients with recent myocardial infarction and left-ventricular dysfunction: a randomised trial". Lancet. 356 (9247): 2052–8. PMID 11145491. Retrieved 2011-04-19. Unknown parameter |month= ignored (help)
  13. Eldar M, Canetti M, Rotstein Z, Boyko V, Gottlieb S, Kaplinsky E, Behar S (1998). "Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups". Circulation. 97 (10): 965–70. PMID 9529264. Retrieved 2011-04-19. Unknown parameter |month= ignored (help)
  14. Danchin N, Fauchier L, Marijon E, Barnay C, Furber A, Mabo P, Bernard P, Blanc JJ, Jouven X, Le Heuzey JY, Charbonnier B, Ferrières J, Simon T (2010). "Impact of early statin therapy on development of atrial fibrillation at the acute stage of myocardial infarction: data from the FAST-MI register". Heart (British Cardiac Society). 96 (22): 1809–14. doi:10.1136/hrt.2010.201574. PMID 20965993. Retrieved 2011-04-18. Unknown parameter |month= ignored (help)
  15. 15.0 15.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA; et al. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
  16. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  17. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  18. Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199


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