Arrhythmias Complicating Acute Myocardial Infarction: Atrial Tachyarrhythmias Including Atrial Fibrillation and Atrial Flutter

  • Dan L. Musat
  • Jonathan S. Steinberg
  • Delia Cotiga
  • Eyal Herzog

In patients presenting with acute coronary syndrome (ACS), supraventricular tachyarrhythmias (SVTs) are relatively common in the peri-infarction period. Their occurrence often heralds signifi cant myocardial ischemia with ventricular dysfunction or cardiogenic shock and may, in themselves, cause congestive heart failure and exacerbate ongoing myocardial ischemia. They also are a predictor of short- and long-term complications and prognosis [1–4].

Atrial tachyarrhythmias or narrow QRS complex tachycardias are defi ned as tachyarrhythmias with a rate faster than 100 beats per minute (bpm) and a QRS duration of less than 120 milliseconds (0.12 second), as demonstrated on the electrocardiogram (ECG) or cardiac monitor [5]. SVT is considered any tachyar-rhythmia that requires atrial or atrioventricular junctional tissue for its initiation and maintenance [6].


Acute Myocardial Infarction Right Coronary Artery Atrial Tachycardia Atrial Arrhythmia Ventricular Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bandiera A, Rosanio S, Tocchi M, et al. Supraventricular hyperkinetic arrhythmias in acute myocardial infarct: their prognostic assessment and correlation with the echocardiographic evolution. Cardiologia 1994;39:633–639.PubMedGoogle Scholar
  2. 2.
    Brazdzionyte J, Baksyte G. Risk assessment in acute myocardial infarction. Medicina (Kaunas) 2004;40:121–126.Google Scholar
  3. 3.
    Crimm A, Severance HW, Coffey K, et al. Prognostic significance of isolated sinus tachycardia during first three days of acute myocardial infarction. Am J Med 1984; 76:983–988.PubMedCrossRefGoogle Scholar
  4. 4.
    Becker RC, Burns M, Gore JM, et al. Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes: a nationwide perspective of current clinical practice. The National Registry of Myo-cardial Infarction (NRMI-2). Am Heart J 1998;135:786–796.Google Scholar
  5. 5.
    Arnsdorf MF, Ganz LI. Approach to narrow QRS complex tachycardias. Up to date. 14.2 ed. 2006.Google Scholar
  6. 6.
    Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Braunwald E, Zipes DP, eds. Zipes: Braunwald's heart disease: a textbook of cardiovascular medicine, 7th ed. Philadelphia: WB Saunders; 2005:803–836.Google Scholar
  7. 7.
    Podrid PJ. Supraventricular arrhythmias after myocardial infarction. Up to date. 14.2 ed. 2006.Google Scholar
  8. 8.
    Madias JE, Patel DC, Singh D. Atrial fibrillation in acute myocardial infarction: a prospective study based on data from a consecutive series of patients admitted to the coronary care unit. Clin Cardiol 1996;19:180–186.PubMedCrossRefGoogle Scholar
  9. 9.
    Blumlein SL, Armstrong R, Haywood LJ. Atrial fl utter associated with acute myo-cardial infarction. West J Med 1981;135:97–103.PubMedGoogle Scholar
  10. 10.
    Tjandrawidjaja MC, Fu Y, Kim DH, et al. Compromised atrial coronary anatomy is associated with atrial arrhythmias and atrioventricular block complicating acute myocardial infarction. J Electrocardiol 2005;38:271–278.PubMedCrossRefGoogle Scholar
  11. 11.
    Goldberg RJ, Seeley D, Becker RC, et al. 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 1990;119:996–1001.PubMedCrossRefGoogle Scholar
  12. 12.
    Galcera TJ, Melgarejo MA, Garcia AA, et al. Incidence, clinical characteristics and prognostic significance of supraventricular tachyarrhythmias in acute myocardial infarction. Rev Esp Cardiol 1999;52:647–655.Google Scholar
  13. 13.
    Crenshaw BS, Ward SR, Granger CB, et al. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. J Am Coll Cardiol 1997;30:406–413.PubMedCrossRefGoogle Scholar
  14. 14.
    Wong CK, White HD, Wilcox RG, et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J 2000;140:878–885.PubMedCrossRefGoogle Scholar
  15. 15.
    Pizzetti F, Turazza FM, Franzosi MG, et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart 2001;86:527–532.PubMedCrossRefGoogle Scholar
  16. 16.
    Eldar M, Canetti M, Rotstein Z, et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. Circulation 1998;97:965–970.Google Scholar
  17. 17.
    Blomström-Lundqvist, Scheinman MM, Aliot EM. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias. J Am Coll Cardiol 2003;42:1493–1531.PubMedCrossRefGoogle Scholar
  18. 18.
    Fogoros R. Abnormal heart rhythms. In: Forgoros R, ed. Electrophysiologic testing. Massachusetts: Blackwell; 2006:12–21.CrossRefGoogle Scholar
  19. 19.
    Aufderheide TP. Arrhythmias associated with acute myocardial infarction and thrombolysis. Emerg Med Clin North Am 1998;16:583–600.PubMedCrossRefGoogle Scholar
  20. 20.
    Antman EM, Braunwald E. ST-elevation myocardial infarction: pathology, patho-physiology, and clinical features; arrhythmias. In: Braunwald E, Zipes DP, eds. Zipes: Braunwald's heart disease: a textbook of cardiovascular medicine. 7th ed. Philadelphia: WB Saunders; 2005:1207–1218.Google Scholar
  21. 21.
    Kyriakidis M, Barbetseas J, Antonopoulos A, et al. Early atrial arrhythmias in acute myocardial infarction. Role of the sinus node artery. Chest 1992;101:944–947.Google Scholar
  22. 22.
    Hod J, Lew AS, Keltai M. Early atrial fibrillation during evolving myocardial infarction: a consequence of impaired left atrial perfusion. Circulation 1987;75:146– 150.PubMedGoogle Scholar
  23. 23.
    Lokshyn S, Mewis C, Kuhlkamp V. Atrial fibrillation in coronary artery disease. Int J Cardiol 2000;72:133–136.PubMedCrossRefGoogle Scholar
  24. 24.
    Celik S, Erdol C, Baykan M, et al. Relation between paroxysmal atrial fibrillation and left ventricular diastolic function in patients with acute myocardial infarction. Am J Cardiol 2001;88:160–162.PubMedCrossRefGoogle Scholar
  25. 25.
    Serrano CV Jr, Ramires JA, Mansur AP, et al. Importance of the time of onset of supraventricular tachyarrhythmias on prognosis of patients with acute myocardial infarction. Clin Cardiol 1995;18:84–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Latoguz IK, Ovcharenko LI, Shapkin EI, et al. Pathogenetic mechanisms of the development of cardiac rhythm disorders in the acute period of myocardial infarction. Kardiologiia 1988;28:38–41.PubMedGoogle Scholar
  27. 27.
    Kyriakidis M, Vyssoulis G, Barbetseas J, et al. A clinical angiographic study of the arterial blood supply to the sinus node. Chest 1988;94:1054–1057.PubMedCrossRefGoogle Scholar
  28. 28.
    James TN, Burch GE. The atrial coronary arteries in man. Circulation 1958;17:90– 98.PubMedGoogle Scholar
  29. 29.
    Gensini GG, Buonanno C, Palacio A. Anatomy of the coronary circulation in living man. Dis Chest 1967;52:125.PubMedCrossRefGoogle Scholar
  30. 30.
    Nielsen FE, Andersen HH, Gram-Hansen P, et al. The relationship between ECG signs of atrial infarction and the development of supraventricular arrhy-thmias in patients with acute myocardial infarction. Am Heart J 1992;123:69–72.PubMedCrossRefGoogle Scholar
  31. 31.
    Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Braunwald DPZE, ed. Zipes: Braunwald's heart disease: a textbook of cardiovascular medicine. 7th ed. Philadelphia: WB Saunders; 2005:803–863.Google Scholar
  32. 32.
    Berisso MZ, Ferroni A, Molini D, et al. Supraventricular tachyarrhythmias during acute myocardial infarction: short- and mid-term clinical significance, therapy and prevention of relapse. G Ital Cardiol 1991;21:49–58.PubMedGoogle Scholar
  33. 33.
    Herzog E, Saint-Jacques H, Rozanski A. The PAIN pathway as a tool to bridge the gap between evidence and management of acute coronary syndrome. Crit Pathways Cardiol 2004;3:20–24.Google Scholar
  34. 34.
    Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004; 110:588–636.PubMedCrossRefGoogle Scholar
  35. 35.
    Herzog E, Steinberg JS. Management of atrial fibrillation and atrial flutter. In: Cannon CPOGP, ed. Critical pathways in cardiovascular medicine. 2nd ed: Philadelphia: Lippincott Williams & Wilkins; 2006:181–189.Google Scholar
  36. 36.
    Dalzell GW, Anderson J, Adgey AA. Factors determining success and energy requirement for cardioversion of atrial fibrillation. Q J Med 1990;76:903–913.PubMedGoogle Scholar
  37. 37.
    Gallagher MM, Guo XH, Poloniecki JD, et al. Initial energy sitting, outcome and efficiency in direct current cardioversion of atrial fibrillation. J Am Coll Cardiol 2001;38:1498–1504.PubMedCrossRefGoogle Scholar
  38. 38.
    Boriani G, Diemberger I, BiffiM, et al. Pharmacological cardioversion of atrial fibrillation: current management and treatment options. Drugs 2004;64:2741– 2762.PubMedCrossRefGoogle Scholar
  39. 39.
    Kirchhof O, Eckardt L, Loh P, et al. Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation. Lancet 2002;360:1275–1279.PubMedCrossRefGoogle Scholar
  40. 40.
    Myerburg RJ, Castellanos A. Electrode positioning for cardioversion of atrial fibril-lation. Lancet 2002;360:1263–1264.PubMedCrossRefGoogle Scholar
  41. 41.
    Page RL, Kerber RE, Russell JK, et al. Biphasic versus monophasic shock waveform for conversion of atrial fibrillation. The result of an international randomized, double-blind multicenter trial. J Am Coll Cardial 2002;39:1956–1963.Google Scholar
  42. 42.
    Ricard P, Levy S, Trigamo J, et al. Prospective assessment of the minimum energy needed for external cardioversion of atrial fibrillation. Am J Cardiol 1997;79:815– 816.PubMedCrossRefGoogle Scholar
  43. 43.
    Herzog E, Fischer A, Steinberg JS. The rate control, anticoagulation therapy, and electrophysiology/antiarrhythmic medication pathway for the management of atrial fibrillation and atrial flutter. Crit Pathways Cardiol 2005:121–126.Google Scholar
  44. 44.
    Barbier GH, Shettigar UR, Appunn DO. Clinical rationale for the use of an ultra-short acting beta-blocker: esmolol. Int J Clin Pharmacol Ther 1995;33:212–218.PubMedGoogle Scholar
  45. 45.
    Cybulski J, Kulakowski P, Makowska E, et al. Intravenous amiodarone is safe and seems to be effective in termination of paroxysmal supraventricular tachyarrhyth-mias. Clin Cardiol 1996;19:563–566.PubMedCrossRefGoogle Scholar
  46. 46.
    Cameron A, Schwartz MJ, Kronmal RA, et al. Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry). Am J Cardiol 1988;61:714– 717.PubMedCrossRefGoogle Scholar
  47. 47.
    Sakata K, Kurihara H, Iwamori K, et al. Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction. Am J Cardiol 1997;80:1522–1527.PubMedCrossRefGoogle Scholar
  48. 48.
    Huikuri HV, Mahaux V, Bloch-Thomsen PE. Cardiac arrhythmias and risk stratifi-cation after myocardial infarction: results of the CARISMA pilot study. Pacing Clin Electrophysiol 2003;26:416–419.PubMedCrossRefGoogle Scholar
  49. 49.
    Stenestrand U, Lindback J, Wallentin L. 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 2005;112:3225– 3231.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2008

Authors and Affiliations

  • Dan L. Musat
    • 1
  • Jonathan S. Steinberg
    • 2
  • Delia Cotiga
    • 2
  • Eyal Herzog
    1. 1.Department of CardiologySt. Luke's-Roosevelt Hospital Center Columbia University College of Physicians and SurgeonsNew YorkUSA
    2. 2.Division of Cardiology, Department of MedicineSt. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and SurgeonsNew YorkUSA

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