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European Heart Journal Advance Access originally published online on December 24, 2008
European Heart Journal 2009 30(9):1038-1045; doi:10.1093/eurheartj/ehn579
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications

Joern Schmitt1,{dagger}, Gabor Duray1,{dagger}, Bernard J. Gersh2 and Stefan H. Hohnloser1,*

1 Section of Electrophysiology, Division of Cardiology, J.W. Goethe University, Theodor-Stern-Kai 7, D 60590 Frankfurt, Germany
2 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

Received 28 July 2008; revised 1 November 2008; accepted 4 December 2008; online publish-ahead-of-print 24 December 2008.

* Corresponding author. Tel: +49 69 6301 7404, Fax: +49 69 6301 7017, Email: hohnloser{at}em.uni-frankfurt.de

See page 1035 for the editorial comment on this article (doi:10.1093/eurheartj/ehp154)

Atrial fibrillation (AF), the most commonly encountered clinical arrhythmia, often complicates acute myocardial infarction (AMI) with an incidence between 6 and 21%. Predictors of the arrhythmia in the setting of AMI include advanced age, heart failure symptoms, and depressed left ventricular function. The bulk of evidence demonstrates that AF in patients hospitalized for AMI has serious adverse prognostic implications regarding in-hospital, but also long-term mortality. This seems to apply for all patient populations studied without significant differences related to the treatment of AMI (i.e. no reperfusion therapy vs. thrombolysis vs. percutaneous coronary intervention). Mortality is particularly high in patients who have congestive heart failure and/or a reduced left ventricular ejection fraction. Finally, there are persuasive data indicating that AF complicating AMI not only increases the risk for ischaemic stroke during hospitalization but also during follow-up. This seems to apply also for transient AF which has reversed back to sinus rhythm at the time of discharge. These observations emphasize the need for prospective studies evaluating optimal therapeutic approaches for patients with AMI complicated by AF.

Key Words: Atrial fibrillation • Acute myocardial infarction • Acute coronary syndrome • Anticoagulation

{dagger} Both authors contributed equally to this work.


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Related articles in EHJ:

Atrial fibrillation complicating acute myocardial infarction: how should it be interpreted and how should it be treated and prevented?
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EHJ 2009 30: 1035-1037. [Extract] [FREE Full Text]  



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Atrial fibrillation complicating acute myocardial infarction: how should it be interpreted and how should it be treated and prevented?
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