Atrial fibrillation post-myocardial infarction: Frequency, consequences, and management
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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is a frequent complication of acute myocardial infarction (MI). AF occurs in 5% to 10% of patients who have received fibrinolysis. Post-MI AF is more common in older patients, in patients with heart failure, and after more extensive infarction. Postinfarction prognosis is worse among patients complicated by AF—indeed, mortality and morbid events including stroke, thromboembolism, and heart failure are increased in this group. It is unclear as to whether AF directly reduces survival or merely demarcates patients at higher overall risk. Despite its frequent occurrence and deleterious influence on outcomes, randomized data regarding management of AF after acute MI are scarce. This review summarizes recent data charting the incidence of AF after acute MI and describes features associated with its occurrence. Clinical sequelae and current principles in treatment are also discussed.
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References and Recommended Reading
- 11.Carlsson J, Tebbe U, Neuhaus KL, et al. Atrial fibrillation in acute myocardial infarction: data from the inTIME-II study. Circulation 1999, 100(Suppl 1):abstract 2636.Google Scholar
- 13.Rathore SS, Berger AK, Weinfurt KP, et al.: Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 2000, 101:969–974. This large survey of more than 100,000 health care beneficiaries noted that AF independently predicted mortality after AMI.PubMedGoogle Scholar
- 15.Goldberg RJ, Yarzebski J, Lessard D, et al.: Recent trends in the incidence rates of and death rates from atrial fibrillation complicating initial acute myocardial infarction: a community-wide perspective. Am Heart J 2002, 143:519–527. This is an observational study conducted between 1990 and 1997. Incidence of AF after AMI decreased from 18% to 11% during this period. Survival for patients with AF tended to improve.PubMedCrossRefGoogle Scholar
- 19.Rosiak M, Ruta J, Bolinska H: Usefulness of prolonged P-wave duration on signal averaged ECG predicting atrial fibrillation in acute myocardial infarction patients. Med Sci Monit 2003, 9:85–88.Google Scholar
- 25.Wyse DG, Waldo AL, DiMarco JP, et al.: A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002, 347:1825–1833. This is a large, randomized study reporting noninferiority of rate control compared with rhythm control in AF. Whether either strategy is superior in AMI requires evaluation.PubMedCrossRefGoogle Scholar
- 26.ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation--executive summary.Eur Heart J 2001, 20:1852–1923.Google Scholar
- 29.Cairns JA, Connolly SJ, Roberts R, Gent M: Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet 1997, 349:675–682.PubMedCrossRefGoogle Scholar
- 33.Kober L, Bloch Thomsen PE, Moller M, et al.: Effect of dofetilide in patients with recent myocardial infarction and left-ventricular dysfunction: a randomised trial. Lancet 2000, 356:2052–2058. This paper reviews the use of dofetilide versus placebo in recent MI patients with ejection fraction less than 35%. Dofetilide did not increase mortality and appeared effective in cardioverting AF in the subgroup.PubMedCrossRefGoogle Scholar
- 34.Wong CK, White HD, Wilcox RG, et al.: Management and outcome of patients with atrial fibrillation during acute myocardial infarction: the GUSTO-III experience. Global Use of Strategies to Open Occluded Coronary Arteries. Heart 2002, 88:357–362. In this observational substudy, class I antiarrhythmic and sotalol treatment associated a with trend toward better survival, but not improved cardioversion.PubMedCrossRefGoogle Scholar