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New-onset versus chronic atrial fibrillation in acute myocardial infarction: differences in short- and long-term follow-up

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Abstract

Aims

Atrial fibrillation (AF) occurs commonly in patients with acute myocardial infarction (AMI) and has been established as a marker of adverse prognosis. There are only few clinical trials that investigate differences between new-onset and chronic AF in AMI. We hypothesize that chronic AF is associated with an increased rate of adverse short- and long-term outcomes.

Methods and results

In a single center study, over a period of 28 months, 375 consecutive patients with AMI were included [337 patients without AF (89.9%) and 38 with AF (10.1%)]. As much as 16 patients had new-onset AF (42.1%) and 22 had chronic AF (57.9%). Patients with severe coronary artery disease develop AF more often in AMI, and the existence of AF was associated with a poor prognosis. Compared to patients with new-onset AF, chronic AF was more frequently associated with advanced age (75 vs. 70 years, p not significant), reduced left ventricular ejection fraction (44.8 vs. 54.0%, p < 0.05) and NSTEMI (63.6 vs. 36.4%, p < 0.05). Only chronic AF resulted in increased in-hospital death (18.2 vs. 0.0%; p < 0.005) at the 2-year follow-up, 14 patients with AF died (63.6%), predominantly due to cardiovascular reasons.

Conclusion

Our results indicate that patients with chronic AF had a higher incidence of in-hospital death than those with new-onset AF or without. Chronic AF includes a group of older and sicker patients than their counterparts with new-onset AF. Understanding these findings may ultimately lead to better care of patients with this arrhythmia to prevent the development of the underlying atrial substrate in chronic AF patients and to improve their otherwise worse prognosis.

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Abbreviations

AF:

Atrial fibrillation

AMI:

Acute myocardial infarction

CAD:

Coronary artery disease

LAD:

Left anterior descending coronary artery

LCx:

Left circumflex coronary artery

LVEF:

Left ventricular ejection fraction

NSTEMI:

Non-ST elevation myocardial infarction

OAC(s):

Oral anticoagulant(s)

PCI:

Primary coronary intervention

RCA:

Right coronary artery

STEMI:

ST-elevation myocardial infarction

References

  1. Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98:946–952

    CAS  PubMed  Google Scholar 

  2. Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB (2007) Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J Am Coll Cardiol 49:986–992

    Article  PubMed  Google Scholar 

  3. Lopes RD, Pieper KS, Horton JR et al (2008) Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation. Heart 94:867–873

    Article  CAS  PubMed  Google Scholar 

  4. Pizzetti F, Turazza FM, Franzosi MG et al (2001) Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart 86:527–532

    Article  CAS  PubMed  Google Scholar 

  5. Behar S, Zahavi Z, Goldbourt U, Reicher-Reiss H (1992) Long-term prognosis of patients with paroxysmal atrial fibrillation complicating acute myocardial infarction. SPRINT Study Group. Eur Heart J 13:45–50

    CAS  PubMed  Google Scholar 

  6. Pedersen OD, Bagger H, Kober L, Torp-Pedersen C (1999) The occurrence and prognostic significance of atrial fibrillation/flutter following acute myocardial infarction TRACE Study group TRAndolapril Cardiac Evalution. Eur Heart J 20:748–754

    Article  CAS  PubMed  Google Scholar 

  7. Rathore SS, Berger AK, Weinfurt KP et al (2000) Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 101:969–974

    CAS  PubMed  Google Scholar 

  8. Wong CK, White HD, Wilcox RG, Criger DA, Califf RM, Topol EJ, Ohmann EM (2002) GUSTO-III Investigators 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 88:357–362

    Article  PubMed  Google Scholar 

  9. Pritchett ELC (1992) Management of atrial fibrillation. N Engl J Med 326:1264–1271

    Article  CAS  PubMed  Google Scholar 

  10. 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. Am Heart J 119:996–1001

    Article  CAS  PubMed  Google Scholar 

  11. Sakata K, Kurihara H, Iwamori K et al (1997) Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction. Am J Cardiol 80:1522–1527

    Article  CAS  PubMed  Google Scholar 

  12. Schmitt J, Duray G, Gersh BJ, Hohnloser SH (2009) Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J 30:1038–1045

    Article  PubMed  Google Scholar 

  13. Kinjo K, Sato H, Sato H, Ohnishi Y, Hishida E, Nakatani D (2003) Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol 92:1150–1154

    Article  PubMed  Google Scholar 

  14. Mehta RH, Dabbous OH, Granger CB et al (2003) Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. Am J Cardiol 92:1031–1036

    Article  PubMed  Google Scholar 

  15. Al-Khatib SM, Pieper KS, Lee KL et al (2001) Atrial fibrillation and mortality among patients with acute coronary syndromes without ST-segment elevation: results from the PURSUIT trial. Am J Cardiol 88(A7):76–79

    Article  Google Scholar 

  16. Berton G, Cordiano R, Cucchini F, Cavuto F, Pellegrinet M, Palatini P (2009) Atrial fibrillation during acute myocardial infarction: association with all-cause mortality and sudden death after 7-year of follow-up. Int J Clin Pract 63:712–721

    Article  CAS  PubMed  Google Scholar 

  17. Campbell CL, Steinhubl SR (2008) Atrial fibrillation in the setting of acute myocardial infarction–irregulary irregular treatment. A Heart J 155(2):197–199

    Article  Google Scholar 

  18. Cappato R (2009) Atrial fibrillation complicating acute myocardial infarction: how should it be interpreted and how should it be treated and prevented. Eur Heart J 30:1035–1037

    Article  PubMed  Google Scholar 

  19. Killip T III, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20(4):457–464

    Article  PubMed  Google Scholar 

  20. Gage BF, Watermann AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285:2864–2870

    Article  CAS  PubMed  Google Scholar 

  21. Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, Jørgensen E, Marco J, Nordrehaug JE, Ruzyllo W, Urban P, Stone GW, Wijns W (2005) Task force for percutaneous coronary interventions of the European Society of Cardiology Guidelines for Percutaneous Coronary Interventions. Eur Heart J 26:804–847

    Article  PubMed  Google Scholar 

  22. Lehto M, Snapinn S, Dickstein K, Swedberg K, Niemienen MS (2005) OPTIMAAL Investigators Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the OPTIMAAL experience. Eur Heart J 26:350–356

    Article  PubMed  Google Scholar 

  23. 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 30:406–413

    Article  CAS  PubMed  Google Scholar 

  24. Eldar M, Canetti M, Rotstein Z, Boyko V, Gottlieb S, Kaplinsky E (1998) Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era SPRINT and Thrombolytic Survey Groups. Circulation 97:965–970

    CAS  PubMed  Google Scholar 

  25. Lau DH, Huynh LT, Chew DP, Astley CM, Soman A, Sanders P (2009) Prognostic impact of types of atrial fibrillation in acute coronary syndromes. Am J Cardiol 104(10):1317–1323

    Article  PubMed  Google Scholar 

  26. Stenestrand U, Lindback J, Wallentin L (2005) Anticoagulation therapy in atrial fibrillation in combination with acute myocardial infarction influences long-term outcome: a prospective cohort study from the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA). Circulation 112:3225–3231

    Article  CAS  PubMed  Google Scholar 

  27. Meissner A, Plehn G et al. (2009) First experiences for pulmonary vein isolation with the high-density mesh ablator (HDMA): a novel mesh electrode catheter for both mapping and radiofrequency delivery in a single unit. J Cardiovasc Electrophysiol. 20(4):359–366

    Google Scholar 

  28. Pappone C, Rosanio S, Augello G et al (2003) Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 42:185–197

    Article  PubMed  Google Scholar 

  29. Sanders P, Jaïs P, Hocini M et al (2004) Electrophysiologic and clinical consequences of linear catheter ablation to transect the anterior left atrium in patients with atrial fibrillation. Heart Rhythm 1:176–184

    Article  PubMed  Google Scholar 

  30. Wazni OM, Marrouche NF, Martin DO et al (2005) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 293:2634–2640

    Article  CAS  PubMed  Google Scholar 

  31. Khan MN, Jaïs P, Cummings J et al (2008) Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med 359:1778–1785

    Article  CAS  PubMed  Google Scholar 

  32. Meissner A, Plehn G et al. (2009) Segmental pulmonary vein isolation in atrial fibrillation: new insights from the high density mesh mapper technique in an electrophysiologically guided approach. J Interv Card Electrophysiol 25(3):183–192

    Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology and Pneumology, Medizinische Klinik II (Cardiology and Pneumology), St. Marien Hospital Lünen, Academic Teaching Hospital of the University of Münster, Altstadtstr. 23, 44534, Lünen, Germany

    Petra Maagh & Ingo Wickenbrock

  2. Department of Cardiology and Angiology, Ruhr-University Bochum/Germany, Hölkeskampring 40, 45625, Herne, Germany

    Thomas Butz, Magnus Wilhelm Prull, Gunnar Plehn, Hans-Joachim Trappe & Axel Meissner

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  1. Petra Maagh
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  2. Thomas Butz
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  3. Ingo Wickenbrock
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  4. Magnus Wilhelm Prull
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Correspondence to Petra Maagh.

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Maagh, P., Butz, T., Wickenbrock, I. et al. New-onset versus chronic atrial fibrillation in acute myocardial infarction: differences in short- and long-term follow-up. Clin Res Cardiol 100, 167–175 (2011). https://doi.org/10.1007/s00392-010-0227-6

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  • DOI: https://doi.org/10.1007/s00392-010-0227-6

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