Atrial fibrillation acute myocardial infarction: Difference between revisions
Jump to navigation
Jump to search
Varun Kumar (talk | contribs) No edit summary |
Varun Kumar (talk | contribs) No edit summary |
||
| Line 30: | Line 30: | ||
==Incidence== | ==Incidence and prevalence== | ||
*There are varied estimates about incidence and prevalence of [[atrial fibrillation]] in patients with [[coronary artery disease]](CAD). | |||
*Data on 18,343 patients with [[CAD]] in the Coronary Artery Surgery Study (CASS) 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>. | |||
*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 [[atrial fibrillation]] ([[AF]]) complicating [[myocardial infarction]] ([[MI]]) to be 16%. | *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 [[atrial fibrillation]] ([[AF]]) complicating [[myocardial infarction]] ([[MI]]) to be 16%. | ||
*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 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>. | ||
==Pathophysiology== | |||
Atrial fibrillation in the setting of acute myocardial infarction is due to: | |||
#Atrial dysfunction secondary to atrial ischemia/infarction as a consequence of | |||
#*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>. | |||
#*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]]. | |||
#Sympathetic stimulation. | |||
#Iatrogenic factors. | |||
==Clinical trial data== | ==Clinical trial data== | ||
| Line 42: | Line 52: | ||
*'''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 nonsevere event during [[MI]]. | *'''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 nonsevere event during [[MI]]. | ||
==Treatment== | |||
==ACC / AHA Guidelines- Acute Myocardial Infarction (DO NOT EDIT) <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref> | '''ACC / AHA Guidelines- Acute Myocardial Infarction (DO NOT EDIT) <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>''' | ||
{{cquote| | {{cquote| | ||
===Class I=== | ===Class I=== | ||
Revision as of 14:50, 19 April 2011
| Conduction | ||
Sinus rhythm  |
Atrial fibrillation  | |
| Atrihttp://miles.wikidoc.org/skins/common/images/button_bold.pngal fibrillation | |
 | |
|---|---|
| The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation. | |
| ICD-10 | I48 |
| ICD-9 | 427.31 |
| DiseasesDB | 1065 |
| MedlinePlus | 000184 |
| eMedicine | med/184 emerg/46 |
| Cardiology Network |
 Discuss Atrial fibrillation acute myocardial infarction further in the WikiDoc Cardiology Network |
| Adult Congenital |
|---|
| Biomarkers |
| Cardiac Rehabilitation |
| Congestive Heart Failure |
| CT Angiography |
| Echocardiography |
| Electrophysiology |
| Cardiology General |
| Genetics |
| Health Economics |
| Hypertension |
| Interventional Cardiology |
| MRI |
| Nuclear Cardiology |
| Peripheral Arterial Disease |
| Prevention |
| Public Policy |
| Pulmonary Embolism |
| Stable Angina |
| Valvular Heart Disease |
| Vascular Medicine |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Synonyms and related keywords: AF, Afib, fib
Incidence and prevalence
- There are varied estimates about incidence and prevalence of atrial fibrillation in patients with coronary artery disease(CAD).
- Data on 18,343 patients with CAD in the Coronary Artery Surgery Study (CASS) reported that AF was found to be present in 116 (0.6%) patients[1].
- A community-wide study[2] reported an overall incidence of atrial fibrillation (AF) complicating myocardial infarction (MI) to be 16%.
- Majority of atrial arrhythmias in the setting of MI usually occurs within first 72hrs[3].
Pathophysiology
Atrial fibrillation in the setting of acute myocardial infarction is due to:
- Atrial dysfunction secondary to atrial ischemia/infarction as a consequence of
- Proximal left circumflex artery occlusion prior to atrial branch[4].
- Poor blood flow down the atrioventricular branch of the right coronary artery which affect the functioning of AV and SA node.
- Increased left atrial pressure as a consequence of left ventricular dysfunction.
- Sympathetic stimulation.
- Iatrogenic factors.
Clinical trial data
- GUSTO-1 trial[5] involving 40,891 patients reported 2.5% patients had AF at the time of admission and 7.9% patients had AF 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-III trial[6] involving 13,858 patients reported patients with AF had a greater 30-day and 1-year mortality.
- GISSI-3 trial[7] and the TRACE trial[8] concluded AF after MI was a independent worst prognostic indicator for both short-term and long-term mortality.
- PURSUIT trail[9] demonstrated increased 30-day and 6-month mortality in patients who developed AF in the setting of Unstable angina/NSTEMI.
- Meta-Analysis[10] 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 nonsevere event during MI.
Treatment
ACC / AHA Guidelines- Acute Myocardial Infarction (DO NOT EDIT) [11]
| “ |
Class I1. 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. (Level of Evidence: C) 2. Intravenous administration of amiodarone is recommended to slow a rapid ventricular response to AF and improve LV function in patients with acute MI. (Level of Evidence: C) 3. Intravenous beta blockers and non dihydropyridine calcium channel antagonists are recommended to slow a rapid ventricular response to AF in patients with acute MI who do not display clinical LV dysfunction, bronchospasm, or AV block. (Level of Evidence: C) 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. (Level of Evidence: C) Class IIa1. 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 heart failure. (Level of Evidence: C) Class III1. The administration of class IC antiarrhythmic drugs is not recommended in patients with AF in the setting of acute MI. (Level of Evidence: C) |
” |
Prevention
- Early statin therapy[12] 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.
See Also
Sources
- The ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [11]
References
- ↑ 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) - ↑ 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) - ↑ JAMES TN (1961). "Myocardial infarction and atrial arrhythmias". Circulation. 24: 761–76. PMID 14451030. Retrieved 2011-04-18. Unknown parameter
|month=ignored (help) - ↑ 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) - ↑ 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". Journal of the American College of Cardiology. 30 (2): 406–13. PMID 9247512. Retrieved 2011-04-18. Unknown parameter
|month=ignored (help) - ↑ 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) - ↑ 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) - ↑ 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) - ↑ 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) - ↑ 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) - ↑ 11.0 11.1 Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781
- ↑ 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)
Further Readings
- Fuster V, Rydén LE, Cannom DS, 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.
- Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular 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 Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120
de:Vorhofflimmern it:Fibrillazione atriale nl:Boezemfibrilleren no:Atrieflimmer fi:Eteisvärinä