Atrial fibrillation acute myocardial infarction: Difference between revisions

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| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]
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{{Atrial fibrillation}}
{{Atrial fibrillation}}


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==Overview==
==Overview==
[[MI|Acute MI]] patients with the [[AF]] have been shown to have an increased incidence of in-hospital mortality and worst prognosis.<ref name="pmid10704162">Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ et al. (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10704162 Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes.] ''Circulation'' 101 (9):969-74. PMID: [http://pubmed.gov/10704162 10704162]</ref> The incidence of [[stroke]] is also higher in patients with [[MI]] and [[AF]] than those without [[AF]].<ref name="pmid9247512">Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9247512 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: [http://pubmed.gov/9247512 9247512]</ref>
[[atrium|Atrial]] dysfunction secondary to [[atrium|atrial]] [[ischemia]] and increased left [[atrium|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]] ([[coronary artery disease|CAD]]). Another study reported an overall [[incidence]] of [[atrial fibrillation]] complicating [[myocardial infarction]] ([[myocardial infarction|MI]]) to be 16%. The management of new onset [[atrial fibrillation]] after [[myocardial infarction]] ([[myocardial infarction|MI]]) is important, because majority of the [[patients]] with hemodynamic compromise during [[atrial fibrillation]] is a result of rapid [[ventricle|ventricular]] rate which increases [[cardiac muscle|myocardial]] [[oxygen]] demand, thereby exacerbating ongoing [[ischemia]] and possibly decreasing [[cardiac output]].
 
==Pathophysiology==
==Pathophysiology==
[[Atrial fibrillation]] in the setting of [[acute myocardial infarction]] is due to:
The following are [[pathogenesis]] of [[atrial fibrillation]] in the setting of [[acute myocardial infarction]]:<ref name="pmid10704162">Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ et al. (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10704162 Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes.] ''Circulation'' 101 (9):969-74. PMID: [http://pubmed.gov/10704162 10704162]</ref><ref name="pmid9247512">Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9247512 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: [http://pubmed.gov/9247512 9247512]</ref><ref name="pmid3791600">{{cite journal |author=Hod H, Lew AS, Keltai M, Cercek B, Geft IL, Shah PK, Ganz W |title=Early atrial fibrillation during evolving myocardial infarction: a consequence of impaired left atrial perfusion |journal=[[Circulation]] |volume=75 |issue=1 |pages=146–50 |year=1987 |month=January |pmid=3791600 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=3791600 |accessdate=2011-04-19}}</ref>
*Atrial dysfunction secondary to atrial [[ischemia]]/[[infarction]] as a consequence of
*[[atrium|Atrial]] dysfunction secondary to [[atrium|atrial]] [[ischemia]]/[[infarction]] as a consequence of the following:
**Proximal [[left circumflex artery]] occlusion prior to atrial branch.<ref name="pmid3791600">{{cite journal |author=Hod H, Lew AS, Keltai M, Cercek B, Geft IL, Shah PK, Ganz W |title=Early atrial fibrillation during evolving myocardial infarction: a consequence of impaired left atrial perfusion |journal=[[Circulation]] |volume=75 |issue=1 |pages=146–50 |year=1987 |month=January |pmid=3791600 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=3791600 |accessdate=2011-04-19}}</ref>
**Proximal [[left circumflex artery]] occlusion prior to [[atrium|atrial]] branch
**Poor blood flow down the atrioventricular branch of the [[right coronary artery]] which affect the functioning of [[AV node|AV]] and [[SA node]].
**Poor [[blood]] flow down the atrioventricular branch of the [[right coronary artery]] which affect the functioning of [[AV node|AV]] and [[SA node]]
*Increased left atrial pressure as a consequence of [[left ventricular dysfunction]].
*Increased left [[atrium|atrial]] [[pressure]] as a consequence of [[left ventricular dysfunction]]  
*Sympathetic stimulation.
*[[Sympathetic nervous system|Sympathetic]] stimulation
*Iatrogenic factors.
*[[Iatrogenesis|Iatrogenic factors]]


==Epidemiology and Demographics==
==Epidemiology and Demographics==
*There are varied estimates about incidence and prevalence of [[atrial fibrillation]] ([[AF]], [[Afib]]) in patients with [[coronary artery disease]](CAD).
*There are varied estimates about [[incidence]] and [[prevalence]] of [[atrial fibrillation]] (or [[Afib]]) in [[patients]] with [[coronary artery disease]] ([[coronary artery disease|CAD]]).


*Coronary Artery Surgery Study (CASS) reported that [[AF]] was found to be present in 0.6% patients with [[CAD]]<ref name="pmid3258467">{{cite journal |author=Cameron A, Schwartz MJ, Kronmal RA, Kosinski AS |title=Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry) |journal=[[The American Journal of Cardiology]] |volume=61 |issue=10 |pages=714–7 |year=1988 |month=April |pmid=3258467 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(88)91053-3 |accessdate=2011-04-19}}</ref>.
*Coronary Artery Surgery Study (CASS) reported that [[atrial fibrillation]] was found to be present in 0.6% [[patients]] with [[coronary artery disease]] ([[coronary artery disease|CAD]]).<ref name="pmid3258467">{{cite journal |author=Cameron A, Schwartz MJ, Kronmal RA, Kosinski AS |title=Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry) |journal=[[The American Journal of Cardiology]] |volume=61 |issue=10 |pages=714–7 |year=1988 |month=April |pmid=3258467 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(88)91053-3 |accessdate=2011-04-19}}</ref>


*A community-wide study<ref name="pmid2330889">{{cite journal |author=Goldberg RJ, Seeley D, Becker RC, Brady P, Chen ZY, Osganian V, Gore JM, Alpert JS, Dalen JE |title=Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective |journal=[[American Heart Journal]] |volume=119 |issue=5 |pages=996–1001 |year=1990 |month=May |pmid=2330889 |doi= |url= |accessdate=2011-04-18}}</ref> reported an overall incidence of [[Afib]] complicating [[myocardial infarction]] ([[MI]]) to be 16%.
*A community-wide study reported an overall [[incidence]] of [[atrial fibrillation]] complicating [[myocardial infarction]] ([[myocardial infarction|MI]]) to be 16%.<ref name="pmid2330889">{{cite journal |author=Goldberg RJ, Seeley D, Becker RC, Brady P, Chen ZY, Osganian V, Gore JM, Alpert JS, Dalen JE |title=Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective |journal=[[American Heart Journal]] |volume=119 |issue=5 |pages=996–1001 |year=1990 |month=May |pmid=2330889 |doi= |url= |accessdate=2011-04-18}}</ref>  
*Majority of [[atrial arrhythmias]] in the setting of [[MI]] usually occurs within first 72hrs<ref name="pmid14451030">{{cite journal |author=JAMES TN |title=Myocardial infarction and atrial arrhythmias |journal=[[Circulation]] |volume=24 |issue= |pages=761–76 |year=1961 |month=October |pmid=14451030 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14451030 |accessdate=2011-04-18}}</ref>.
*Majority of [[atrial arrhythmias]] in the setting of [[MI]] usually occurs within first 72 hours<ref name="pmid14451030">{{cite journal |author=JAMES TN |title=Myocardial infarction and atrial arrhythmias |journal=[[Circulation]] |volume=24 |issue= |pages=761–76 |year=1961 |month=October |pmid=14451030 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14451030 |accessdate=2011-04-18}}</ref>.


==Clinical Trial Data==
==Clinical Trial Data==
*'''Coronary Artery Surgery Study (CASS)''' involving 18,343 patients with [[CAD]] reported that [[AF]] was found to be present in 116 (0.6%) patients<ref name="pmid3258467">{{cite journal |author=Cameron A, Schwartz MJ, Kronmal RA, Kosinski AS |title=Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry) |journal=[[The American Journal of Cardiology]] |volume=61 |issue=10 |pages=714–7 |year=1988 |month=April |pmid=3258467 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(88)91053-3 |accessdate=2011-04-19}}</ref>.
*'''Coronary Artery Surgery Study (CASS)''' involving 18,343 [[patients]] with [[coronary artery disease]] ([[coronary artery disease|CAD]]) reported that [[atrial fibrillation]] was found to be present in 116 (0.6%) [[patients]].<ref name="pmid3258467">{{cite journal |author=Cameron A, Schwartz MJ, Kronmal RA, Kosinski AS |title=Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry) |journal=[[The American Journal of Cardiology]] |volume=61 |issue=10 |pages=714–7 |year=1988 |month=April |pmid=3258467 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(88)91053-3 |accessdate=2011-04-19}}</ref>


*'''GUSTO-I trial'''<ref name="pmid9247512">{{cite journal |author=Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM |title=Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries |journal=[[Journal of the American College of Cardiology]] |volume=30 |issue=2 |pages=406–13 |year=1997 |month=August |pmid=9247512 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109797001940 |accessdate=2011-04-18}}</ref> involving 40,891 patients reported 2.5% patients had Afib at the time of admission and 7.9% patients had Afib at the time of randomization who frequently had triple vessel disease. The study concluded [[atrial fibrillation]] to be an independent predictor of [[stroke]] and 30-day mortality in the setting of acute [[MI]].
*'''GUSTO-I trial''' involving 40,891 [[patients]] reported 2.5% [[patients]] had [[atrial fibrillation]] at the time of admission and 7.9% [[patients]] had [[atrial fibrillation]] at the time of randomization who frequently had triple vessel [[disease]]. The study concluded [[atrial fibrillation]] to be an independent predictor of [[stroke]] and 30-day [[mortality rate|mortality]] in the setting of acute [[myocardial infarction]] ([[myocardial infarction|MI]]).<ref name="pmid9247512">{{cite journal |author=Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM |title=Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries |journal=[[Journal of the American College of Cardiology]] |volume=30 |issue=2 |pages=406–13 |year=1997 |month=August |pmid=9247512 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109797001940 |accessdate=2011-04-18}}</ref>


*'''GUSTO-III trial'''<ref name="pmid11099991">{{cite journal |author=Wong CK, White HD, Wilcox RG, Criger DA, Califf RM, Topol EJ, Ohman EM |title=New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience |journal=[[American Heart Journal]] |volume=140 |issue=6 |pages=878–85 |year=2000 |month=December |pmid=11099991 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870300807772 |accessdate=2011-04-18}}</ref> involving 13,858 patients reported patients with [[AF]] had a greater 30-day and 1-year mortality.
*'''GUSTO-III trial''' involving 13,858 [[patients]] reported patients with [[atrial fibrillation]] had a greater 30-day and 1-year [[mortality rate|mortality]].<ref name="pmid11099991">{{cite journal |author=Wong CK, White HD, Wilcox RG, Criger DA, Califf RM, Topol EJ, Ohman EM |title=New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience |journal=[[American Heart Journal]] |volume=140 |issue=6 |pages=878–85 |year=2000 |month=December |pmid=11099991 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870300807772 |accessdate=2011-04-18}}</ref>


*'''GISSI-3 trial'''<ref name="pmid11602545">{{cite journal |author=Pizzetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, Maggioni AP, Santoro L, Tognoni G |title=Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data |journal=[[Heart (British Cardiac Society)]] |volume=86 |issue=5 |pages=527–32 |year=2001 |month=November |pmid=11602545 |pmc=1729969 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=11602545 |accessdate=2011-04-18}}</ref> and the '''TRACE trial'''<ref name="pmid10329066">{{cite journal |author=Pedersen OD, Bagger H, Køber L, Torp-Pedersen C |title=The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evalution |journal=[[European Heart Journal]] |volume=20 |issue=10 |pages=748–54 |year=1999 |month=May |pmid=10329066 |doi= |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=10329066 |accessdate=2011-04-18}}</ref> concluded [[AF]] after [[MI]] was a independent worst prognostic indicator for both short-term and long-term mortality.
*'''GISSI-3 trial''' and the '''TRACE trial''' concluded [[atrial fibrillation]] after [[myocardial infarction]] ([[myocardial infarction|MI]]) was a independent worst [[prognosis|prognostic]] indicator for both short-term and long-term [[mortality rate|mortality]].<ref name="pmid11602545">{{cite journal |author=Pizzetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, Maggioni AP, Santoro L, Tognoni G |title=Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data |journal=[[Heart (British Cardiac Society)]] |volume=86 |issue=5 |pages=527–32 |year=2001 |month=November |pmid=11602545 |pmc=1729969 |doi= |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=11602545 |accessdate=2011-04-18}}</ref><ref name="pmid10329066">{{cite journal |author=Pedersen OD, Bagger H, Køber L, Torp-Pedersen C |title=The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evalution |journal=[[European Heart Journal]] |volume=20 |issue=10 |pages=748–54 |year=1999 |month=May |pmid=10329066 |doi= |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=10329066 |accessdate=2011-04-18}}</ref>


*'''PURSUIT trail'''<ref name="pmid11423065">{{cite journal |author=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 |title=Atrial fibrillation and mortality among patients with acute coronary syndromes without ST-segment elevation: results from the PURSUIT trial |journal=[[The American Journal of Cardiology]] |volume=88 |issue=1 |pages=A7, 76–9 |year=2001 |month=July |pmid=11423065 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914901015934 |accessdate=2011-04-18}}</ref> demonstrated increased 30-day and 6-month mortality in patients who developed [[AF]] in the setting of [[unstable angina]]/[[NSTEMI]].
*'''PURSUIT trail''' demonstrated increased 30-day and 6-month [[mortality rate|mortality]] in [[patients]] who developed [[atrial fibrillation]] in the setting of [[unstable angina]]/[[NSTEMI]].<ref name="pmid11423065">{{cite journal |author=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 |title=Atrial fibrillation and mortality among patients with acute coronary syndromes without ST-segment elevation: results from the PURSUIT trial |journal=[[The American Journal of Cardiology]] |volume=88 |issue=1 |pages=A7, 76–9 |year=2001 |month=July |pmid=11423065 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002914901015934 |accessdate=2011-04-18}}</ref>


*'''Meta-Analysis'''<ref name="pmid21464054">{{cite journal |author=Jabre P, Roger VL, Murad MH, Chamberlain AM, Prokop L, Adnet F, Jouven X |title=Mortality Associated With Atrial Fibrillation in Patients With Myocardial Infarction: A Systematic Review and Meta-Analysis |journal=[[Circulation]] |volume= |issue= |pages= |year=2011 |month=April |pmid=21464054 |doi=10.1161/CIRCULATIONAHA.110.986661 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21464054 |accessdate=2011-04-18}}</ref> involving 278 854 patients from 1970 – 2010 reported that the presence of a new onset [[AF]] after [[MI]] was associated with increased mortality even after adjusting several important risk factors for AF. Mortality odds ratio associated with AF was 1.46 while that of new onset AF was 1.37 and prior AF was 1.28 suggesting that AF is no longer a non severe event during [[MI]].
*'''Meta-Analysis''' involving 278 854 [[patients]] from 1970 – 2010 reported that the presence of a new onset [[atrial fibrillation]] after [[myocardial infarction]] ([[myocardial infarction|MI]]) was associated with increased [[mortality rate|mortality]] even after adjusting several important [[risk factors]] for [[atrial fibrillation]]. [[mortality rate|Mortality]] [[odds ratio]] associated with [[atrial fibrillation]] was 1.46 while that of new onset [[atrial fibrillation]] was 1.37 and prior [[atrial fibrillation]] was 1.28 suggesting that [[atrial fibrillation]] is no longer a non severe event during [[myocardial infarction]] ([[myocardial infarction|MI]]).<ref name="pmid21464054">{{cite journal |author=Jabre P, Roger VL, Murad MH, Chamberlain AM, Prokop L, Adnet F, Jouven X |title=Mortality Associated With Atrial Fibrillation in Patients With Myocardial Infarction: A Systematic Review and Meta-Analysis |journal=[[Circulation]] |volume= |issue= |pages= |year=2011 |month=April |pmid=21464054 |doi=10.1161/CIRCULATIONAHA.110.986661 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21464054 |accessdate=2011-04-18}}</ref>


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


====Hemodynamically Unstable====
====Hemodynamically Unstable====
*[[Direct-current cardioversion]] (biphasic shock of 100 J or monophasic shock of 200 J)
*[[Direct-current cardioversion]] (biphasic shock of 100 J or monophasic shock of 200 J)


*If non-responsive to [[cardioversion]] or [[Afib]] recurs, IV-[[amiodarone]] is indicated to control rate and maintain sinus rhythm.  [[Dofetilide]] is also another effective drug to maintain sinus rhythm in patients with new onset AF after [[MI]]<ref name="pmid11145491">{{cite journal |author=Køber L, Bloch Thomsen PE, Møller M, Torp-Pedersen C, Carlsen J, Sandøe E, Egstrup K, Agner E, Videbaek J, Marchant B, Camm AJ |title=Effect of dofetilide in patients with recent myocardial infarction and left-ventricular dysfunction: a randomised trial |journal=[[Lancet]] |volume=356 |issue=9247 |pages=2052–8 |year=2000 |month=December |pmid=11145491 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673600034024 |accessdate=2011-04-19}}</ref>.
*If non-responsive to [[cardioversion]] or [[atrial fibrillation]] recurs, [[Intravenous therapy|IV]]-[[amiodarone]] is indicated to control rate and maintain [[sinus rhythm]].  [[Dofetilide]] is also another effective [[medication|drug]] to maintain [[sinus rhythm]] in [[patients]] with new onset [[atrial fibrillation]] after [[myocardial infarction]] ([[myocardial infarction|MI]]).<ref name="pmid11145491">{{cite journal |author=Køber L, Bloch Thomsen PE, Møller M, Torp-Pedersen C, Carlsen J, Sandøe E, Egstrup K, Agner E, Videbaek J, Marchant B, Camm AJ |title=Effect of dofetilide in patients with recent myocardial infarction and left-ventricular dysfunction: a randomised trial |journal=[[Lancet]] |volume=356 |issue=9247 |pages=2052–8 |year=2000 |month=December |pmid=11145491 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673600034024 |accessdate=2011-04-19}}</ref>


*Hemodynamic compromise in [[AF]] is mostly due to rapid ventricular rate, for which IV-[[beta blocker]]  or IV-[[verapamil]] is recommended as [[amiodarone]] and [[digoxin]] only gradually slow the atrioventricular conduction.
*Hemodynamic compromise in [[atrial fibrillation]] is mostly due to rapid [[ventricle|ventricular rate]], for which [[Intravenous therapy|IV]]-[[beta blocker]]  or [[Intravenous therapy|IV]]-[[verapamil]] is recommended as [[amiodarone]] and [[digoxin]] only gradually slow the atrioventricular conduction.


====Hemodynamically Stable====
====Hemodynamically Stable====
*Rate control with IV-[[beta blocker]] (unless contra-indicated) and [[anticoagulation]] is indicated.
*Rate control with [[Intravenous therapy|IV]]-[[beta blocker]] (unless [[contraindication|contraindicated]]) and [[anticoagulation]] is indicated.


*[[Cardioversion]] is indicated in patients without a history of [[AF]] prior to [[MI]].
*[[Cardioversion]] is indicated in [[patients]] without a history of [[atrial fibrillation]] prior to [[myocardial infarction]] ([[myocardial infarction|MI]]).


*Long-term [[antiarrhythmic]] therapy is indicated only in cases of recurrent [[AF]] associated with [[heart failure]] or severe [[left ventricular systolic dysfunction]]<ref name="pmid9529264">{{cite journal |author=Eldar M, Canetti M, Rotstein Z, Boyko V, Gottlieb S, Kaplinsky E, Behar S |title=Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups |journal=[[Circulation]] |volume=97 |issue=10 |pages=965–70 |year=1998 |month=March |pmid=9529264 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9529264 |accessdate=2011-04-19}}</ref>.
*Long-term [[antiarrhythmic]] [[therapy]] is indicated only in cases of recurrent [[atrial fibrillation]] associated with [[heart failure]] or severe [[left ventricular systolic dysfunction]].<ref name="pmid9529264">{{cite journal |author=Eldar M, Canetti M, Rotstein Z, Boyko V, Gottlieb S, Kaplinsky E, Behar S |title=Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups |journal=[[Circulation]] |volume=97 |issue=10 |pages=965–70 |year=1998 |month=March |pmid=9529264 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9529264 |accessdate=2011-04-19}}</ref>


====Anticoagulation: New Onset Sustained Afib after MI====
====Anticoagulation: New Onset Sustained Afib after MI====
*If the new onset AF is of known duration, AF can be [[cardioverted]] within 24hours without the need for [[anticoagulation]] after [[cardioversion]].
*If the new onset [[atrial fibrillation]] is of known duration, [[atrial fibrillation]] can be [[cardioversion|cardioverted]] within 24 hours without the need for [[anticoagulation]] after [[cardioversion]].


*If the AF is of unknown duration, [[Transesophageal echocardiography]] (TEE) is recommended before [[cardioversion]] (depending on the patients hemodynamic status) and [[anticoagulation]] with [[heparin]] followed by [[warfarin]] or [[dabigatran]] after [[cardioversion]].
*If the [[atrial fibrillation]] is of unknown duration, [[transesophageal echocardiography]] ([[transesophageal echocardiography|TEE]]) is recommended before [[cardioversion]] (depending on the [[patients]] hemodynamic status) and [[anticoagulation]] with [[heparin]] followed by [[warfarin]] or [[dabigatran]] after [[cardioversion]].


*[[Anticoagulation]] is usually not recommended for patients with a single episode of AF after [[MI]], however patients with recurrent or chronic AF should receive oral [[anticoagulation]] based on the [[CHADS Score|CHADS<sub>2</sub> Score]] assessment.
*[[Anticoagulation]] is usually not recommended for [[patients]] with a single episode of [[atrial fibrillation]] after [[myocardial infarction]] ([[myocardial infarction|MI]]), however [[patients]] with recurrent or [[Chronic (medical)|chronic]] [[atrial fibrillation]] should receive [[mouth|oral]] [[anticoagulation]] based on the [[CHADS Score|CHADS<sub>2</sub> Score]] assessment.


==Prevention==
===Prevention===
Early [[statin]] therapy<ref name="pmid20965993">{{cite journal |author=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 |title=Impact of early statin therapy on development of atrial fibrillation at the acute stage of myocardial infarction: data from the FAST-MI register |journal=[[Heart (British Cardiac Society)]] |volume=96 |issue=22 |pages=1809–14 |year=2010 |month=November |pmid=20965993 |doi=10.1136/hrt.2010.201574 |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=20965993 |accessdate=2011-04-18}}</ref> is indicated in [[ischemic heart disease]], after cardiac [[bypass surgery]], and to reduce [[AF]] recurrences. However it is not recommended to prevent [[AF]] in patients with [[MI]].
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]] ([[myocardial infarction|MI]]).<ref name="pmid20965993">{{cite journal |author=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 |title=Impact of early statin therapy on development of atrial fibrillation at the acute stage of myocardial infarction: data from the FAST-MI register |journal=[[Heart (British Cardiac Society)]] |volume=96 |issue=22 |pages=1809–14 |year=2010 |month=November |pmid=20965993 |doi=10.1136/hrt.2010.201574 |url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=20965993 |accessdate=2011-04-18}}</ref>


==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)<ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=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. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>==
==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)<ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=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. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>==
===Acute Myocardial Infarction (DO NOT EDIT)<ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=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. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>===
===Acute Myocardial Infarction (DO NOT EDIT)<ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=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. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>===


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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''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 [[MI]] and [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Direct-current [[cardioversion]] is recommended for [[patients]] with severe [[Hemodynamics|hemodynamic compromise]] or intractable [[ischemia]], or when adequate rate control cannot be achieved with [[pharmacology|pharmacological agents]] in [[patients]] with acute [[myocardial infarction]] ([[myocardial infarction|MI]]) and [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Intravenous administration of [[amiodarone]] is recommended to slow a rapid ventricular response to [[AF]] and improve LV function in patients with acute [[MI]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Intravenous]] administration of [[amiodarone]] is recommended to slow a rapid [[ventricle|ventricular]] response to [[atrial fibrillation]] and improve [[ventricle|LV]] function in [[patients]] with acute [[myocardial infarction]] ([[myocardial infarction|MI]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Intravenous [[beta blockers]] and nondihydropyridine [[calcium antagonists]] are recommended to slow a rapid ventricular response to [[AF]] in patients with acute [[MI]] who do not have [[LV dysfunction]], bronchospasm, or [[AV block]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Intravenous]] [[beta blockers]] and nondihydropyridine [[calcium antagonists]] are recommended to slow a rapid [[ventricle|ventricular]] response to [[atrial fibrillation]] in [[patients]] with acute [[myocardial infarction]] ([[myocardial infarction|MI]]) who do not have [[LV dysfunction]], [[bronchospasm]], or [[AV block]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' For patients with [[AF]] and acute [[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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' For [[patients]] with [[atrial fibrillation]] and acute [[myocardial infarction]] ([[myocardial infarction|MI]]), administration of unfractionated [[heparin]] by either continuous [[Intravenous therapy|intravenous]] [[Intravenous therapy|infusion]] or intermittent [[Subcutaneous tissue|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 [[Anticoagulant|anticoagulation]] exist. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 83: Line 99:
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' The administration of class IC antiarrhythmic drugs is not recommended in patients with [[AF]] in the setting of acute [[MI]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' The administration of [[Antiarrhythmic agent|class IC antiarrhythmic drugs]] is not recommended in [[patients]] with [[atrial fibrillation]] in the setting of acute [[myocardial infarction]] ([[myocardial infarction|MI]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 90: Line 106:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous administration of [[digitalis]] is reasonable to slow a rapid ventricular response and improve LV function in patients with acute [[MI]] and [[AF]] associated with severe [[LV dysfunction]] and [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Intravenous]] administration of [[digitalis]] is reasonable to slow a rapid [[ventricle|ventricular response]] and improve [[ventricle|LV function]] in [[patients]] with acute [[myocardial infarction]] ([[myocardial infarction|MI]]) and [[atrial fibrillation]] associated with severe [[LV dysfunction]] and [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 102: Line 118:
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[CME Category::Cardiology]]


[[Category:Electrophysiology]]
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Latest revision as of 05:26, 3 September 2021
Resident
Survival
Guide
File:Critical Pathways.gif

Sinus rhythm
Atrial fibrillation

Atrial Fibrillation Microchapters

Home

Patient Information

Overview

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Differentiating Atrial Fibrillation from other Diseases

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Postoperative AF
Acute Myocardial Infarction
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Overview
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Atrial fibrillation acute myocardial infarction On the Web

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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

  1. ↑ Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ et al. (2000) Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 101 (9):969-74. PMID: 10704162
  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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