Atrial fibrillation acute myocardial infarction

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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

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Synonyms and related keywords: AF, Afib, fib


Incidence

  • A community-wide study[1] reported an overall incidence of AF complicating MI to be 16%.
  • Majority of atrial arrhythmias in the setting of MI usually occurs within first 72hrs[2].


Clinical trial data

  • GUSTO-1 trial[3] 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[4] involving 13,858 patients reported patients with AF had a greater 30-day and 1-year mortality.


ACC / AHA Guidelines- Acute Myocardial Infarction (DO NOT EDIT) [5]

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 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 IIa

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 heart failure. (Level of Evidence: C)

Class III

1. 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


See Also

Sources

  • The ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [5]

References

  1. 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)
  2. JAMES TN (1961). "Myocardial infarction and atrial arrhythmias". Circulation. 24: 761–76. PMID 14451030. Retrieved 2011-04-18. Unknown parameter |month= ignored (help)
  3. 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)
  4. 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)
  5. 5.0 5.1 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
  6. 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

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