1
|
Di C, Wang H, Wang M, Wang Q, Wu Y, Li L, Zhang Y, Lin W. Acute atrial infarction: a relatively neglected and under-recognized entity in clinical practice. Herz 2024:10.1007/s00059-024-05272-z. [PMID: 39316092 DOI: 10.1007/s00059-024-05272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/25/2024] [Accepted: 08/20/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Electrocardiograms (ECGs) and angiographic features indicative of acute atrial infarction (AAI) often go unnoticed and are under-recognized in clinical practice. METHODS In this retrospective observational study, we analyzed the data of 3981 out of 9803 patients (40.61%) who were referred to our hospital for angiography and/or percutaneous coronary intervention due to acute coronary syndrome (ACS). These patients were diagnosed with acute ST segment elevation myocardial infarction (AMI) affecting the inferior, posterior, and/or right ventricular regions. RESULTS Of the 3981 patients, 270 (6.78%) had involvement of the main coronary atrial branch meeting the angiographic criteria for AAI. Among the 270 patients identified, the right coronary artery was diagnosed as the infarct-related artery (IRA) in 187 patients (group R), while the left circumflex artery was the IRA in 83 patients (group L). The incidence of PR-segment deviation was similar between the two groups (65.2% in group R vs. 66.3% in group L, p = 0.870), as was occurrence of atrial tachyarrhythmia (67.4% vs. 55.4%, p = 0.059). The prevalence of P wave morphology abnormalities (29.9% vs. 49.4%, p = 0.005) and sinus bradycardia or arrest (25.1% vs. 66.3%, p < 0.001) was significantly lower in Group R than in Group L. CONCLUSION Acute atrial infarction represents a distinct yet frequently overlooked clinical entity. Clinicians should consider the potential for atrial arrhythmias, thromboembolism, hemodynamic instability, and atrial rupture when diagnosing AAI.
Collapse
Affiliation(s)
- Chengye Di
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, 300457, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Haijiang Wang
- Cardiac Interventional Center, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Mingming Wang
- Cardiac Interventional Center, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Qun Wang
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, 300457, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Yanxi Wu
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, 300457, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Longyu Li
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, 300457, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Yan Zhang
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, 300457, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Wenhua Lin
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, 300457, Tianjin, China.
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China.
- Cardiovascular Institute, Tianjin University, Tianjin, China.
| |
Collapse
|
2
|
Ren H, Wang Z, Li Y, Liu J. Association of lipopolysaccharide with new-onset atrial fibrillation in ST-segment elevation myocardial infarction. Heliyon 2024; 10:e27552. [PMID: 38496897 PMCID: PMC10944234 DOI: 10.1016/j.heliyon.2024.e27552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
Background Lipopolysaccharide (LPS) is related to various cardiovascular diseases. However, the relationship between LPS and new-onset atrial fibrillation (NOAF) after ST-segment elevation myocardial infarction (STEMI) has yet to be elucidated. This study aimed to evaluate the impact of LPS on NOAF in STEMI patients. Methods This was a single-center retrospective observational study including 806 patients diagnosed with STEMI. LPS levels were determined using a commercial ELISA kit. NOAF was characterized by postadmission AF with the absence of any prior history of AF. Results A total of 806 participants were enrolled, with 752 individuals in the non-AF group (93.3%) and 54 individuals in the AF group (6.7%). Multivariable analysis showed that LPS (OR = 1.047; 95% CI: 1.029-1.065, P < 0.001) was an independent risk marker for NOAF. The analysis of the ROC demonstrated that LPS had an AUC of 0.717 in predicting NOAF. When LPS was added to the conventional model, the ability of the risk model to discriminate and reclassify NOAF was improved significantly (IDI 0.053, P = 0.001; NRI 0.510, P < 0.001). Conclusion Elevated LPS is associated with an increased risk of NOAF in STEMI patients. The integration of LPS can improve the ability to predict NOAF in STEMI patients.
Collapse
Affiliation(s)
- Honglong Ren
- Department of Gastroenterology, The First People's Hospital of Yuhang District, Hangzhou, 311100, Zhejiang, China
| | - Zhonghua Wang
- Department of Gastroenterology, The First People's Hospital of Yuhang District, Hangzhou, 311100, Zhejiang, China
| | - Yong Li
- Department of Cardiology, The First People's Hospital of Yuhang District, Hangzhou, 311100, Zhejiang, China
| | - Jinqi Liu
- Department of Cardiology, Huai'an Second People's Hospital, 223001, Jiangsu, China
| |
Collapse
|
3
|
Zeng Q, Li W, Luo Z, Zhou H, Duan Z, Xiong XL. The role of miR1 and miR133a in new-onset atrial fibrillation after acute myocardial infarction. BMC Cardiovasc Disord 2023; 23:448. [PMID: 37697243 PMCID: PMC10496401 DOI: 10.1186/s12872-023-03462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The development of new-onset atrial fibrillation (NOAF) after acute myocardial infarction (AMI) is a clinical complication that requires a better understanding of the causative risk factors. This study aimed to explore the risk factors and the expression and function of miR-1 and miR-133a in new atrial fibrillation after AMI. METHODS We collected clinical data from 172 patients with AMI treated with emergency percutaneous coronary intervention (PCI) between October 2021 and October 2022. Independent predictors of NOAF were determined using binary logistic univariate and multivariate regression analyses. The predictive value of NOAF was assessed using the area under the receiver operating characteristic (ROC) curve for related risk factors. In total, 172 venous blood samples were collected preoperatively and on the first day postoperatively; the expression levels of miR-1 and miR-133a were determined using the polymerase chain reaction. The clinical significance of miR-1 and miR-133a expression levels was determined by Spearman correlation analysis. RESULTS The Glasgow prognostic score, left atrial diameter, and infarct area were significant independent risk factors for NOAF after AMI. We observed that the expression levels of miR-1 and miR-133a were significantly higher in the NOAF group than in the non-NOAF group. On postoperative day 1, strong associations were found between miR-133a expression levels and the neutrophil ratio and between miR-1 expression levels and an increased left atrial diameter. CONCLUSIONS Our findings indicate that the mechanism of NOAF after AMI may include an inflammatory response associated with an increased miR-1-related mechanism. Conversely, miR-133a could play a protective role in this clinical condition.
Collapse
Affiliation(s)
- Qingyi Zeng
- Guizhou Medical University, 9 Beijing Road, Guiyang, 550000, Guizhou, China
- The Second Affiliated Hospital of Guizhou University of Chinese Medicine, 83 Feishan Street, Guiyang, China
| | - Wei Li
- Guizhou Medical University, 9 Beijing Road, Guiyang, 550000, Guizhou, China.
- Affiliated Hospital of Guizhou Medical University, 16 Beijing Road, Guiyang, 550000, Guizhou, China.
| | - Zhenghua Luo
- Guizhou Provincial People's Hospital, 83 Zhongshan East Road, Guiyang, 55000, Guizhou, China
| | - Haiyan Zhou
- Guizhou Medical University, 9 Beijing Road, Guiyang, 550000, Guizhou, China
- Affiliated Hospital of Guizhou Medical University, 16 Beijing Road, Guiyang, 550000, Guizhou, China
| | - Zhonggang Duan
- Guizhou Medical University, 9 Beijing Road, Guiyang, 550000, Guizhou, China
- Affiliated Hospital of Guizhou Medical University, 16 Beijing Road, Guiyang, 550000, Guizhou, China
| | - Xin Lin Xiong
- Guizhou Medical University, 9 Beijing Road, Guiyang, 550000, Guizhou, China
- Affiliated Hospital of Guizhou Medical University, 16 Beijing Road, Guiyang, 550000, Guizhou, China
| |
Collapse
|
4
|
Marazzato J, Blasi F, Golino M, Verdecchia P, Angeli F, De Ponti R. Hypertension and Arrhythmias: A Clinical Overview of the Pathophysiology-Driven Management of Cardiac Arrhythmias in Hypertensive Patients. J Cardiovasc Dev Dis 2022; 9:jcdd9040110. [PMID: 35448086 PMCID: PMC9025699 DOI: 10.3390/jcdd9040110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/26/2022] [Accepted: 04/02/2022] [Indexed: 02/06/2023] Open
Abstract
Because of demographic aging, the prevalence of arterial hypertension (HTN) and cardiac arrhythmias, namely atrial fibrillation (AF), is progressively increasing. Not only are these clinical entities strongly connected, but, acting with a synergistic effect, their association may cause a worse clinical outcome in patients already at risk of ischemic and/or haemorrhagic stroke and, consequently, disability and death. Despite the well-known association between HTN and AF, several pathogenetic mechanisms underlying the higher risk of AF in hypertensive patients are still incompletely known. Although several trials reported the overall clinical benefit of renin–angiotensin–aldosterone inhibitors in reducing incident AF in HTN, the role of this class of drugs is greatly reduced when AF diagnosis is already established, thus hinting at the urgent need for primary prevention measures to reduce AF occurrence in these patients. Through a thorough review of the available literature in the field, we investigated the basic mechanisms through which HTN is believed to promote AF, summarising the evidence supporting a pathophysiology-driven approach to prevent this arrhythmia in hypertensive patients, including those suffering from primary aldosteronism, a non-negligible and under-recognised cause of secondary HTN. Finally, in the hazy scenario of AF screening in hypertensive patients, we reviewed which patients should be screened, by which modality, and who should be offered oral anticoagulation for stroke prevention.
Collapse
Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (M.G.); (F.A.)
| | - Federico Blasi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (M.G.); (F.A.)
| | - Michele Golino
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (M.G.); (F.A.)
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS, 06100 Perugia, Italy;
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (M.G.); (F.A.)
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (F.B.); (M.G.); (F.A.)
- Correspondence: ; Tel.: +39-0332278934
| |
Collapse
|
5
|
Pathology of sudden death, cardiac arrhythmias, and conduction system. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
6
|
Pokorney SD, Berchuck SI, Chiswell K, Sun JL, Thomas L, Jones WS, Patel MR, Piccini JP. Atrial Branch Coronary Artery Stenosis as a Mechanism for Atrial Fibrillation. Heart Rhythm 2021; 19:1237-1244. [PMID: 34958941 DOI: 10.1016/j.hrthm.2021.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The etiology of atrial fibrillation (AF) is multifactorial and incompletely understood. OBJECTIVE Evaluate the association between coronary artery disease (CAD) affecting atrial tissue and AF. METHODS Patients from a single center with obstructive CAD during cardiac catheterization (1/12007-12/1/2013) were included in a matched case-control analysis, based on the presence or absence of new-onset AF within 12 months post-catheterization. Quantitative measurements of stenosis severity were performed for sinoatrial (SA) nodal artery, atrioventricular (AV) nodal artery, and right intermediate atrial artery (RIAA), as well as the right coronary, left circumflex, and left anterior descending proximal to the take-off for each atrial-level artery. A multivariable logistic regression model identified factors associated with AF. RESULTS Among 1,794 patients, 115 (6%) developed AF within 1-year post-catheterization. The matched cohort included 110 patients with and 110 patients without AF within 12 months post-catheterization. Higher odds of AF at 1 year were associated with increasing lesion stenosis severity in the RIAA (OR 1.41 per 10% increase >50%, 95% CI 1.01-1.97, p=0.047) and AV nodal artery (OR 1.58 per 10% increase >50%, 95% CI 1.00-2.49, p=0.050). Odds of AF diagnosis during the year post-catheterization increased with the number of atrial arteries with >50% lesion (OR 1.53 for each additional artery, 95% CI 1.08-2.15, p=0.015). CONCLUSIONS Among patients with obstructive CAD, disease of the AV nodal artery and RIAA, as well as higher burden of CAD within all arteries supplying blood flow to the atrial myocardium were associated with higher odds of new-onset AF at 1 year.
Collapse
Affiliation(s)
- Sean D Pokorney
- Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | | | | | | | | | - W Schuyler Jones
- Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Manesh R Patel
- Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Jonathan P Piccini
- Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| |
Collapse
|
7
|
Biccirè FG, Pastori D, Torromeo C, Acconcia MC, Capone S, Ferrari I, Pannarale G, Paravati V, Gaudio C, Tanzilli G, Barillà F. Acute atrial ischemia associates with early but not late new-onset atrial fibrillation in STEMI patients treated with primary PCI: relationship with in-hospital outcomes. J Cardiol 2021; 78:368-374. [PMID: 34130874 DOI: 10.1016/j.jjcc.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF), both early (EAF) or late (LAF), may complicate ST-segment elevation myocardial infarction (STEMI). The mechanisms underlying EAF or LAF are poorly described. We investigated atrial branch occlusion and EAF or LAF onset in STEMI patients undergoing primary percutaneous coronary intervention. METHODS This was a retrospective cohort study including 155 STEMI patients. Patients were divided into 3 groups: sinus rhythm (SR), EAF, or LAF. Clinical characteristics, angiographic features including occlusion of atrial branches, namely ramus ostia cavae superioris (ROCS), atrio-ventricular node artery (AVNA), right intermediate atrial artery (RIAA), and left intermediate atrial artery, were assessed. We also investigated in-hospital adverse events (AEs) and death. RESULTS Mean age was 63.8±11.9 years; 78.7% were men. NOAF was detected in 22 (14.2%) patients: 10 (6.4%) EAF and 12 LAF (7.7%). Compared to EAF, LAF patients were older (p=0.013), with higher GRACE risk score (p=0.014) and Killip class (p=0.015), depressed ejection fraction (p=0.007), elevated filling pressures (p=0.029), higher C-reactive protein (p=0.014) and more with thrombolysis in myocardial infarction flow <3 (p=0.015). Compared to SR, EAF was associated with higher prevalence of occluded ROCS (p=0.010), AVNA (p=0.005), and RIAA (p<0.001). Moreover, EAF patients had more frequently ≥2 diseased atrial branches than SR (19.5%, p<0.001) and LAF (25%, p<0.030) patients. LAF patients had a higher in-hospital AEs (p=0.019 vs SR; p=0.029 vs EAF) and death (p=0.004 vs SR). CONCLUSIONS The occlusion of atrial branches is associated with EAF but not LAF following STEMI. LAF patients had worse in-hospital AEs and mortality.
Collapse
Affiliation(s)
- Flavio Giuseppe Biccirè
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
| | - Concetta Torromeo
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Cristina Acconcia
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Capone
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Ilaria Ferrari
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Pannarale
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Paravati
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Gaudio
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gaetano Tanzilli
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Barillà
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Italy
| |
Collapse
|
8
|
Dudink EAMP, Bidar E, Jacobs J, van Hunnik A, Zeemering S, Weijs B, Luermans JGLM, Maesen BAE, Cheriex EC, Maessen JG, Hoorntje JCA, Schotten U, Crijns HJGM, Verheule S. The relation between the atrial blood supply and the complexity of acute atrial fibrillation. IJC HEART & VASCULATURE 2021; 34:100794. [PMID: 34095447 PMCID: PMC8164021 DOI: 10.1016/j.ijcha.2021.100794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Background Patients with a history of myocardial infarction and coronary artery disease (CAD) have a higher risk of developing AF. Conversely, patients with atrial fibrillation (AF) have a higher risk of developing myocardial infarction, suggesting a link in underlying pathophysiology. The aim of this study was to assess whether coronary angiographic parameters are associated with a substrate for AF in patients without a history of AF. Methods During cardiac surgery in 62 patients (coronary artery bypass grafting (CABG;n = 47), aortic valve replacement (AVR;n = 9) or CABG + AVR (n = 6)) without a history of clinical AF (age 65.4 ± 8.5 years, 26.2% female), AF was induced by burst pacing. The preoperative coronary angiogram (CAG) was assessed for the severity of CAD, and the adequacy of atrial coronary blood supply as quantified by a novel scoring system including the location and severity of right coronary artery disease in relation to the right atrial branches. Epicardial mapping of the right atrium (256 unipolar electrodes) was used to assess the complexity of induced AF. Results There was no association between the adequacy of right atrial coronary blood supply on preoperative CAG and AF complexity parameters. Multivariable analysis revealed that only increasing age (B0.232 (0.030;0.433),p = 0.03) and the presence of 3VD (B3.602 (0.187;7.018),p = 0.04) were independently associated with an increased maximal activation time difference. Conclusions The adequacy of epicardial right atrial blood supply is not associated with increased complexity of induced atrial fibrillation in patients without a history of clinical AF, while age and the extent of ventricular coronary artery disease are.
Collapse
Affiliation(s)
- Elton A M P Dudink
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Elham Bidar
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiothoracic Surgery, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Judith Jacobs
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Arne van Hunnik
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Stef Zeemering
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Bob Weijs
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Justin G L M Luermans
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Bart A E Maesen
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiothoracic Surgery, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Emile C Cheriex
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Jos G Maessen
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiothoracic Surgery, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Jan C A Hoorntje
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Ulrich Schotten
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Harry J G M Crijns
- Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Sander Verheule
- Maastricht University and Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| |
Collapse
|
9
|
Congo KH, Belo A, Carvalho J, Neves D, Guerreiro R, Pais JA, Brás D, Carrington M, Piçarra B, Santos AR, Aguiar J. New-Onset Atrial Fibrillation in St-Segment Elevation Myocardial Infarction: Predictors and Impact on Therapy And Mortality. Arq Bras Cardiol 2020; 113:948-957. [PMID: 31553385 PMCID: PMC7020966 DOI: 10.5935/abc.20190190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/13/2019] [Indexed: 11/29/2022] Open
Abstract
Backgrund New-onset atrial fibrillation complicating acute myocardial infarction represents an important challenge, with prognostic significance. Objective To study the incidence, impact on therapy and mortality, and to identify predictors of development of new-onset atrial fibrillation during hospital stay for ST-segment elevation myocardial infarction. Methods We studied all patients with ST-elevation myocardial infarction included consecutively, between 2010 and 2017, in a Portuguese national registry and compared two groups: 1 - no atrial fibrillation and 2 - new-onset atrial fibrillation. We adjusted a logistic regression model data analysis to assess the impact of new-onset atrial fibrillation on in-hospital mortality and to identify independent predictors of its development. A p value < 0.05 was considered significant. Results We studied 6325 patients, and new-onset atrial fibrillation was found in 365 (5.8%). Reperfusion was successfully accomplished in both groups with no difference regarding type of reperfusion. In group 2, therapy with beta-blockers and angiotensin-conversion enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) was less frequent, 20.6% received anticoagulation at discharge and 16.1% were on triple therapy. New-onset atrial fibrillation was associated with more in-hospital complications and mortality. However, it was not found as an independent predictor of in-hospital mortality. We identified age, prior stroke, inferior myocardial infarction and complete atrioventricular block as independent predictors of new-onset atrial fibrillation. Conclusion New-onset atrial fibrillation remains a frequent complication of myocardial infarction and is associated with higher rate of complications and in-hospital mortality. Age, prior stroke, inferior myocardial infarction and complete atrioventricular block were independent predictors of new onset atrial fibrillation. Only 36.7% of the patients received anticoagulation at discharge.
Collapse
Affiliation(s)
| | - Adriana Belo
- Centro Nacional Coleção de Dados em Cardiologia, Coimbra - Portugal
| | | | - David Neves
- Hospital Espírito Santo de Évora, Évora - Portugal
| | | | | | - Diogo Brás
- Hospital Espírito Santo de Évora, Évora - Portugal
| | | | | | | | - José Aguiar
- Hospital Espírito Santo de Évora, Évora - Portugal
| |
Collapse
|
10
|
Montero Cabezas JM, Abou R, Goedemans L, Agüero J, Schalij MJ, Ajmone Marsan N, Fuster V, Ibáñez B, Bax JJ, Delgado V. Procedural-related coronary atrial branch occlusion during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction and atrial arrhythmias at follow-up. Catheter Cardiovasc Interv 2020; 95:686-693. [PMID: 31140745 DOI: 10.1002/ccd.28351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/21/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate the frequency of procedural-related atrial branch occlusion in ST-segment elevation myocardial infarction (STEMI) patients and its association with atrial arrhythmias at 1-year follow-up. BACKGROUND Atrial ischemia due to procedural-related coronary atrial branch occlusion in elective percutaneous coronary intervention (PCI) has been associated with atrial arrhythmias. Its role in a STEMI scenario is unknown. METHODS STEMI patients treated with primary PCI were classified according to the loss or patency of an atrial branch at the end of the procedure. The occurrence of atrial arrhythmias was documented on 24-hr Holter-ECG at 3 and 6 months or on ECG during 1-year follow-up visits. RESULTS Of 900 patients, 355 (age 61 ± 12 years, 79% male) underwent primary PCI involving the origin of an atrial branch. Procedural-related coronary atrial branch occlusion was observed in 18 (5%) individuals). During 1-year follow-up, 33% of patients with procedural-related atrial branch occlusion presented atrial arrhythmias, as compared with 55% in those with a patent atrial branch (p = .088). Age, no previous history of myocardial infarction, and a reduced flow in the culprit vessel were the only independent correlates of atrial arrhythmias. CONCLUSIONS The frequency of procedural-related atrial branch occlusion during primary PCI is low (5%) and is not associated with increased frequency of atrial arrhythmias at 1-year follow-up.
Collapse
Affiliation(s)
| | - Rachid Abou
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurien Goedemans
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaume Agüero
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital Universitari i Politecnic La Fe, Valencia, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain.,IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
11
|
Shiba T, Kondo Y, Senoo K, Nakano M, Okubo K, Ishio N, Shikama N, Kobayashi Y. Proximal Occlusion in the Right Coronary Artery Involving the Atrial Branch as a Strong Predictor of New-Onset Atrial Fibrillation in Acute Myocardial Infarction. Int Heart J 2019; 60:1308-1314. [DOI: 10.1536/ihj.18-713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Taiki Shiba
- Department of Cardiology, Chiba Aoba Municipal Hospital
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Yusuke Kondo
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine
| | - Keitaro Senoo
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine
| | - Masahiro Nakano
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine
| | - Kenji Okubo
- Department of Cardiology, Chiba Aoba Municipal Hospital
| | - Naoki Ishio
- Department of Cardiology, Chiba Aoba Municipal Hospital
| | | | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| |
Collapse
|
12
|
Kondo Y, Kobayashi Y. New-onset atrial fibrillation after atrial ischemia. J Arrhythm 2019; 35:863-864. [PMID: 31844481 PMCID: PMC6898528 DOI: 10.1002/joa3.12233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Yusuke Kondo
- Department of Advanced Cardiorhythm Therapeutics Chiba University Graduate School of Medicine Chiba Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| |
Collapse
|
13
|
Misumida N, Ogunbayo GO, Catanzaro J, Etaee F, Kim SM, Abdel‐Latif A, Ziada KM, Elayi CS. Contemporary practice pattern of permanent pacing for conduction disorders in inferior ST-elevation myocardial infarction. Clin Cardiol 2019; 42:728-734. [PMID: 31173380 PMCID: PMC6671775 DOI: 10.1002/clc.23210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Currently, there is no clear consensus regarding the optimal waiting period before permanent pacemaker implantation in patients with conduction disorders following an inferior myocardial infarction. HYPOTHESIS We aimed to elucidate the contemporary practice pattern of pacing, especially the timing of pacemaker implantation, for sinoatrial node and atrioventricular (AV) conduction disorders following an inferior ST-elevation myocardial infarction (STEMI). METHODS Using the National Inpatient Sample database from 2010 to 2014, we identified patients with a primary diagnosis of inferior STEMI. Primary conduction disorders were classified into: (a) high-degree AV block (HDAVB) consisting of complete AV block or Mobitz-type II second-degree AV block, (b) sinoatrial node dysfunction (SND), and (c) no major conduction disorders. RESULTS Among 66 961 patients, 2706 patients (4.0%) had HDAVB, which mostly consisted of complete AV block (2594 patients). SND was observed in 393 patients (0.6%). Among the 2706 patients with HDAVB, 267 patients (9.9%) underwent permanent pacemaker. In patients with HDAVB, more than one-third (34.9%) of permanent pacemakers were placed within 72 hours after admission. The median interval from admission to permanent pacemaker implantation was 3 days (interquartile range; 2-5 days) for HDAVB vs 4 days (3-6 days) for SND (P < .001). HDAVB was associated with increased in-hospital mortality, whereas SND was not. CONCLUSIONS In patients who developed HDAVB following an inferior STEMI, only one in 10 patients underwent permanent pacemaker implantation. Despite its highly reversible nature, permanent pacemakers were implanted relatively early.
Collapse
Affiliation(s)
- Naoki Misumida
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Gbolahan O. Ogunbayo
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - John Catanzaro
- Devision of Cardiovascular MedicineUniversity of FloridaJacksonvilleFlorida
| | - Farshid Etaee
- Department of CardiologyUniversity of Texas Southwestern Medical CenterDallasTexas
| | - Sun Moon Kim
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Ahmed Abdel‐Latif
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Khaled M. Ziada
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Claude S. Elayi
- Devision of Cardiovascular MedicineUniversity of FloridaJacksonvilleFlorida
| |
Collapse
|
14
|
Rhyou HI, Park TH, Cho YR, Park K, Park JS, Kim MH, Kim YD. Clinical factors associated with the development of atrial fibrillation in the year following STEMI treated by primary PCI. J Cardiol 2018; 71:125-128. [DOI: 10.1016/j.jjcc.2017.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/26/2017] [Accepted: 08/24/2017] [Indexed: 11/30/2022]
|
15
|
Koopmann M, Hinrichs L, Olligs J, Lichtenberg M, Eckardt L, Böse D, Möhlenkamp S, Waltenberger J, Breuckmann F. Cardiac computed tomography in patients with symptomatic new-onset atrial fibrillation, rule-out acute coronary syndrome, but with intermediate pretest probability for coronary artery disease admitted to a chest pain unit. Eur J Med Res 2018; 23:6. [PMID: 29361983 PMCID: PMC5782369 DOI: 10.1186/s40001-018-0303-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
Background Atrial fibrillation (AF) and coronary artery disease (CAD) may be encountered coincidently in a large portion of patients. However, data on coronary artery calcium burden in such patients are lacking. Thus, we sought to determine the value of cardiac computed tomography (CCT) in patients presenting with new-onset AF associated with an intermediate pretest probability for CAD admitted to a chest pain unit (CPU). Methods Calcium scores (CS) of 73 new-onset, symptomatic AF subjects without typical clinical, electrocardiographic, or laboratory signs of acute coronary syndrome (ACS) admitted to our CPU were analyzed. In addition, results from computed tomography angiography (CTA) were related to coronary angiography findings whenever available. Results Calcium scores of zero were found in 25%. Median Agatston score was 77 (interquartile range: 1–270) with gender- and territory-specific dispersal. CS scores above average were present in about 50%, high (> 400)-to-very high (> 1000) CS scores were found in 22%. Overall percentile ranking showed a relative accordance to the reference percentile distribution. Additional CTA was performed in 47%, revealing stenoses in 12%. Coronary angiography was performed in 22% and resulted in coronary intervention or surgical revascularization in 7%. On univariate analysis, CS > 50th percentile failed to serve as an independent determinant of significant stenosis during catheterization. Conclusions Within a CPU setting, relevant CAD was excluded or confirmed in almost 50%, the latter with a high proportion of coronary angiographies and subsequent coronary interventions, underlining the diagnostic value of CCT in symptomatic, non-ACS, new-onset AF patients when admitted to a CPU.
Collapse
Affiliation(s)
- Matthias Koopmann
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Liane Hinrichs
- Department of Anesthesiology, Arnsberg Medical Center, Arnsberg, Germany
| | - Jan Olligs
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | | | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Dirk Böse
- Department of Cardiology, Arnsberg Medical Center, Stolte Ley 5, 59759, Arnsberg, Germany
| | - Stefan Möhlenkamp
- Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Moers, Germany
| | | | - Frank Breuckmann
- Department of Cardiology, Arnsberg Medical Center, Stolte Ley 5, 59759, Arnsberg, Germany.
| |
Collapse
|
16
|
Bai X, Wang K, Yuan Y, Li Q, Dobrzynski H, Boyett MR, Hancox JC, Zhang H. Mechanism underlying impaired cardiac pacemaking rhythm during ischemia: A simulation study. CHAOS (WOODBURY, N.Y.) 2017; 27:093934. [PMID: 28964153 DOI: 10.1063/1.5002664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ischemia in the heart impairs function of the cardiac pacemaker, the sinoatrial node (SAN). However, the ionic mechanisms underlying the ischemia-induced dysfunction of the SAN remain elusive. In order to investigate the ionic mechanisms by which ischemia causes SAN dysfunction, action potential models of rabbit SAN and atrial cells were modified to incorporate extant experimental data of ischemia-induced changes to membrane ion channels and intracellular ion homeostasis. The cell models were incorporated into an anatomically detailed 2D model of the intact SAN-atrium. Using the multi-scale models, the functional impact of ischemia-induced electrical alterations on cardiac pacemaking action potentials (APs) and their conduction was investigated. The effects of vagal tone activity on the regulation of cardiac pacemaker activity in control and ischemic conditions were also investigated. The simulation results showed that at the cellular level ischemia slowed the SAN pacemaking rate, which was mainly attributable to the altered Na+-Ca2+ exchange current and the ATP-sensitive potassium current. In the 2D SAN-atrium tissue model, ischemia slowed down both the pacemaking rate and the conduction velocity of APs into the surrounding atrial tissue. Simulated vagal nerve activity, including the actions of acetylcholine in the model, amplified the effects of ischemia, leading to possible SAN arrest and/or conduction exit block, which are major features of the sick sinus syndrome. In conclusion, this study provides novel insights into understanding the mechanisms by which ischemia alters SAN function, identifying specific conductances as contributors to bradycardia and conduction block.
Collapse
Affiliation(s)
- Xiangyun Bai
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Kuanquan Wang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Yongfeng Yuan
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Qince Li
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Halina Dobrzynski
- Institute of Cardiovascular Sciences, The University of Manchester, M13 9PL Manchester, United Kingdom
| | - Mark R Boyett
- Institute of Cardiovascular Sciences, The University of Manchester, M13 9PL Manchester, United Kingdom
| | - Jules C Hancox
- Biological Physics Group, School of Physics and Astronomy, The University of Manchester, M13 9PL Manchester, United Kingdom
| | - Henggui Zhang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| |
Collapse
|
17
|
Pokorney SD, Piccini JP. Calcified Pipes: You Better Call the Electrician Too. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.004202. [PMID: 26659369 DOI: 10.1161/circimaging.115.004202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sean D Pokorney
- From the Electrophysiology Section, Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC
| | - Jonathan P Piccini
- From the Electrophysiology Section, Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC.
| |
Collapse
|
18
|
Ciulla MM, Astuti M, Carugo S. The atherosclerosis of the sinus node artery is associated with an increased history of supra-ventricular arrhythmias: a retrospective study on 541 standard coronary angiograms. PeerJ 2015; 3:e1156. [PMID: 26336639 PMCID: PMC4556151 DOI: 10.7717/peerj.1156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background. The ischemic damage of the sinus node (SN) is a well known cause of cardiac arrhythmias and can be a consequence of any flow abnormality in the sinus node artery (SNA). Accordingly we aimed this retrospective study to: (1) evaluate the suitability of the standard coronary angiography to study the SNA and (2) determine if the percentage of subjects with a positive retrospective history of supra-ventricular arrhythmias (SVA) differs in patients with normal and diseased SNA ascertained at the time of coronary angiography. Methods and Results. Out of the 541 coronary angiograms reviewed the SNA was visible for its entire course in 486 cases (89.8%). It was found to arise from the right side of the coronary circulation in 266 cases (54.7%) slightly more often than from the left, 219 cases (45.1%). One patient had 2 distinct SNA arising from either side of the coronary circulation. For the second objective, we studied the 333 patients with: (a) coronary artery disease (CAD), (b) properly evaluable SNA and (c) complete clinical history available. In 51 (15.3%) a SNA disease was found, 41.2% of them had a positive SVA history, mainly atrial fibrillation (AF), whereas only 7.4% of patients with a positive history of SVA could be found in the non-SNA diseased. This difference was statistically significant (P < 0.001). Conclusions. (1) The evaluation of the SNA is feasible in clinical practice during a standard coronary angiography; (2) this may be relevant since angiographically detectable SNA disease was significantly associated with a positive history of SVA.
Collapse
Affiliation(s)
- Michele M Ciulla
- Laboratory of Clinical Informatics and Cardiovascular Imaging , Milan , Italy ; Department of Clinical Sciences and Community Health, University of Milan , Milan , Italy
| | - Matteo Astuti
- Department of Clinical Sciences and Community Health, University of Milan , Milan , Italy ; Cardiovascular Diseases Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Stefano Carugo
- Department of Health Sciences, University of Milan , Milan , Italy
| |
Collapse
|
19
|
Álvarez-García J, Vives-Borrás M, Ferrero A, Aizpurua DA, Peñaranda AS, Cinca J. Atrial coronary artery occlusion during elective percutaneous coronary angioplasty. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:270-4. [PMID: 23994037 DOI: 10.1016/j.carrev.2013.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/11/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Atrial arteries arise from the right and left circumflex coronary arteries and they may be accidentally occluded during percutaneous coronary angioplasty; however, this complication is not well known. The aim of our study was to analyze the incidence and risk factors of accidental atrial branch occlusion (ABO) during elective angioplasty. METHODS AND MATERIALS Clinical records and coronary angiography of 200 patients undergoing elective angioplasty were retrospectively analyzed. Atrial branches were identified and in each vessel we measured the luminal diameter, flow grade, and the location of atherosclerotic plaques. Patients were allocated either into the ABO group if atrial branch flow fell from TIMI grades 2-3 to 0-1 after procedure or in the non-ABO group if TIMI flow was preserved. RESULTS Atrial branch occlusion occurred in 43 (21.5%) patients. The atrial branch diameter was larger in non-ABO than in ABO group (1.29mm, SD 0.33 versus 0.97mm, SD 0.22, p=<0.0001). Plaques at atrial branch origin were present in 93% of ABO group, only in 31.8% of non-ABO (p≤0.0001). Predictors of ABO were a cut-off vessel diameter of 1.00mm (ROC 77% sensitivity and 67.5% specificity, p≤0.0001), the presence of atherosclerotic plaque at the ostium of atrial branch and maximal inflation pressure during stenting. CONCLUSIONS The occurrence of ABO is frequent after elective angioplasty of right or circumflex coronary arteries in an experienced interventional center. Risk factors were the diameter and the presence of ostial plaques in the atrial branches, and the maximal inflation pressure during stenting.
Collapse
Affiliation(s)
- Jesús Álvarez-García
- Departament of Cardiology, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
20
|
Alasady M, Shipp NJ, Brooks AG, Lim HS, Lau DH, Barlow D, Kuklik P, Worthley MI, Roberts-Thomson KC, Saint DA, Abhayaratna W, Sanders P. Myocardial infarction and atrial fibrillation: importance of atrial ischemia. Circ Arrhythm Electrophysiol 2013; 6:738-45. [PMID: 23873140 DOI: 10.1161/circep.113.000163] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is associated with the development of atrial fibrillation (AF). We aimed to characterize the atrial abnormalities because of MI and determine the role of ischemia to the AF substrate. METHODS AND RESULTS Forty-four sheep were studied. MI was induced by occlusion of the left circumflex artery (LCX) or left anterior descending artery (LAD). Excluding 11 with fatal arrhythmias, equal groups of animals (LCX; LAD; and sham-operated) underwent sequential electrophysiology study for 45 minutes to determine atrial effective refractory periods, conduction velocity, conduction heterogeneity index, and AF inducibility. Postmortem evaluation was performed with 2,3,5 triphenyl tetrazolium chloride staining. MI resulted in greater left ventricular dysfunction (P<0.05), LA pressure (P<0.0003), and reduction in atrial effective refractory periods (P<0.0001) compared with control. 2,3,5 triphenyl tetrazolium chloride staining demonstrated that the left circumflex artery, and not the LAD, group had atrial infarction. The left circumflex artery group demonstrated the following compared with the LAD or control groups: greater slowing in atrial conduction velocity (P<0.0001 and P<0.001); increased absolute range of conduction phase delay (P<0.001 and P<0.001); increased conduction heterogeneity index (P<0.0001 and P<0.001); greater AF vulnerability (P<0.05 for both); and longer AF duration (P<0.05 for both). LAD group had modest but significant slowing in conduction velocity (P<0.01) but no change in conduction heterogeneity index or AF duration compared with control. CONCLUSIONS Left ventricular infarction, which is known to result in atrial stretch, hemodynamic change, and neurohumoral activation, contributes partially to the atrial abnormalities in MI. Atrial ischemia/infarction results in greater atrial electrophysiological changes and propensity for AF forming the dominant substrate for AF in MI.
Collapse
|
21
|
Detection of concurrent atrial ischemia with continuous monitoring of dynamic PR-segment changes in patients with acute myocardial infarction. J Electrocardiol 2013; 46:324-30. [DOI: 10.1016/j.jelectrocard.2013.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Indexed: 11/20/2022]
|
22
|
Jabre P, Empana JP, Jouven X. Fibrillation atriale et infarctus du myocarde : un risque accru de mortalité. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2013. [DOI: 10.1016/s1878-6480(13)70884-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Gorenek B, Kudaiberdieva G. Atrial fibrillation in acute ST-elevation myocardial infarction: clinical and prognostic features. Curr Cardiol Rev 2013; 8:281-9. [PMID: 22920476 PMCID: PMC3492812 DOI: 10.2174/157340312803760857] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 04/25/2012] [Accepted: 05/03/2012] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia in the setting of acute coronary syndrome and acute ST-elevation myocardial infarction (STEMI). This review summarizes recent evidence on the clinical and prognostic significance of pre-existent and new-onset AF in acute STEMI patients and highlights new emerging predictors of AF development in the era of contemporary treatment.
Collapse
Affiliation(s)
- Bulent Gorenek
- Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | | |
Collapse
|
24
|
Pokorney SD, Rao M, Nilsson KR, Piccini JP. Atrial Fibrillation Complicating Acute Coronary Syndromes. J Atr Fibrillation 2012; 5:611. [PMID: 28496773 PMCID: PMC5153213 DOI: 10.4022/jafib.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/14/2012] [Accepted: 07/19/2012] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation frequently complicates myocardial infarction. Patients with atrial fibrillation complicating acute coronary syndrome have increased morbidity and mortality relative to patients that remain in normal sinus rhythm. No studies have identified a mortality benefit to rhythm control compared with rate control in the setting of acute coronary syndrome. Stroke prevention should be pursued with oral anticoagulation therapy, although the majority of patients with atrial fibrillation associated with acute coronary syndrome receive only antiplatelet therapy. There are several novel oral anticoagulant therapies now available, but these agents have not been well studied in combination with dual antiplatelet therapy. Therefore, warfarin as part of triple therapy is the most conservative approach until additional data becomes available.
Collapse
Affiliation(s)
- Sean D Pokorney
- Duke Center for Atrial Fibrillation/Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center
| | - Meena Rao
- Duke Center for Atrial Fibrillation/Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center
| | - Kent R Nilsson
- Duke Center for Atrial Fibrillation/Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center
- Claude D. Pepper Center Older American Independence Center
| | - Jonathan P Piccini
- Duke Center for Atrial Fibrillation/Cardiac Electrophysiology Section, Division of Cardiology, Duke University Medical Center
- Duke Clinical Research Institute, Durham, NC
| |
Collapse
|
25
|
Abstract
Symptomatic sustained cardiac arrhythmias are frequently observed in in the coronary care unit and often lead to hemodynamic compromise, especially in the presence of multisystem disease. The predominant arrhythmias noted in intensive care units are tachyarrhythmias, particularly atrial fibrillation and flutter, and ventricular tachycardia. Bradycardias, arguably less life-threatening than tachyarrhythmias, can arise from sinus node dysfunction or atrioventricular conduction block; transient vagally-mediated bradycardias are frequently encountered as well. Prompt diagnosis of the patient with tachycardia is critical as treatment depends on the accurate diagnosis of tachycardia mechanism. The electrocardiogram remains the most important diagnostic tool for the evaluation of both wide and narrow complex tachycardia. The electrocardiographic diagnosis of wide complex tachycardia is based on evaluation of atrioventricular relationship and QRS morphology while the diagnosis of narrow complex tachycardia is based on the location and morphology of P waves. It is important for critical care specialists to understand the principles of cardiac arrhythmia diagnosis and remain current with the recent advances in the pharmacologic and non-pharmacologic management of patients with arrhythmias.
Collapse
Affiliation(s)
- Nitish Badhwar
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143, USA.
| | | | | |
Collapse
|
26
|
Jabre P, Jouven X, Adnet F, Thabut G, Bielinski SJ, Weston SA, Roger VL. Atrial fibrillation and death after myocardial infarction: a community study. Circulation 2011; 123:2094-100. [PMID: 21536994 DOI: 10.1161/circulationaha.110.990192] [Citation(s) in RCA: 185] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) often coexists with myocardial infarction (MI), yet its prognostic influence is disputed. Prior reports studied the relationship of AF during early hospitalization for acute MI to the risk of death and could not address the timing of AF in relation to the MI (ie, before, during, after). Furthermore, as data come mostly from clinical trials, their applicability to the community is uncertain. The aims of our study were to assess the occurrence of AF among MI patients, determine whether it has changed over time, and quantify its impact and the impact of its timing on mortality after MI. METHODS AND RESULTS This was a community-based cohort of 3220 patients hospitalized with incident (first-ever) MI from 1983 to 2007 in Olmsted County, MN. Atrial fibrillation was identified by diagnostic codes and ECG. Outcomes were all-cause and cardiovascular death. Atrial fibrillation before MI was identified in 304 patients, and 729 developed AF after MI (218 [30%] within 2 days, 119 [16%] between 3 and 30 days, and 392 [54%] >30 days post-MI). The cumulative incidence of AF after MI at 5 years was 19% and did not change over the calendar year of MI (the incidence of AF was the same regardless of when the MI occurred). During a mean follow-up of 6.6 years, 1638 deaths occurred. AF was associated with an increased risk of death (hazard ratio [95% confidence interval] 3.77 [3.37 to 4.21]), independently of clinical characteristics at the time of MI and heart failure. This risk differed markedly according to the timing of AF, and was the greatest for AF occurring >30 days post MI (hazard ratio [95% confidence interval] 1.63 [1.37 to 1.93] for AF within 2 days, 1.81 [0.45 to 2.27] for AF between 3 and 30 days, and 2.58 [2.21 to 3.00] for AF >30 days post MI). CONCLUSIONS In the community, AF is frequent in the setting of MI. Atrial fibrillation carries an excess risk of death, which is the highest for AF developing >30 days after MI.
Collapse
Affiliation(s)
- Patricia Jabre
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | |
Collapse
|
27
|
Alasady M, Abhayaratna WP, Leong DP, Lim HS, Abed HS, Brooks AG, Mattchoss S, Roberts-Thomson KC, Worthley MI, Chew DP, Sanders P. Coronary artery disease affecting the atrial branches is an independent determinant of atrial fibrillation after myocardial infarction. Heart Rhythm 2011; 8:955-60. [PMID: 21338715 DOI: 10.1016/j.hrthm.2011.02.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND During acute myocardial infarction (MI), the incidence of atrial fibrillation (AF) is 6% to 22%, and its occurrence in this setting is associated with increased short- and long-term morbidity and mortality. OBJECTIVE The purpose of this case control study was evaluate the characteristics associated with the development of new-onset AF. METHODS Of 2,460 consecutive patients with acute MI, 149 (6%) were identified as having AF within 7 days of MI. After excluding patients with prior AF, previously documented heart failure, reduced left ventricular (LV) ejection fraction, valvular heart disease, LV hypertrophy, AF after coronary artery bypass grafting, or pericarditis; we identified 42 AF patients in whom coronary anatomy was assessed by invasive angiography and cardiac structure and function was evaluated using transthoracic echocardiography. Another 42 patients from the same cohort with MI but no AF matched for age, gender, and LV ejection fraction were studied as controls. RESULTS AF patients were more likely to present with an inferior MI (P = .002) but less likely to present with ST-segment elevation MI (P = .02). Univariate associations with AF included indexed left atrial volume (P <.001), LV filling pressure (E/e'; P = .001), right atrial branch disease (P <.001), left atrial branch disease (P = .009), sinoatrial branch disease (P <.001), left main stem disease (P = .02), and time from onset of symptoms to coronary intervention (P = .002). In multivariable analysis, right and left coronary artery atrial branch disease (P = .02) were predictors of AF post-MI. CONCLUSION Coronary artery disease affecting the atrial branches is an independent predictor for the development of AF after MI.
Collapse
Affiliation(s)
- Muayad Alasady
- Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
D'Ascenzi F, Iadanza A, Zacà V, Pierli C, Mondillo S. Subocclusion of the sinus node artery during coronary angioplasty: arrhythmological considerations. Clin Cardiol 2010; 33:E35-7. [PMID: 20641108 PMCID: PMC6652943 DOI: 10.1002/clc.20638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 05/23/2009] [Indexed: 11/07/2022] Open
Abstract
We report the case of a 58-year-old man who developed atrial fibrillation as a result of iatrogenic subocclusion of a diseased sinus node artery, originating from the left circumflex artery (LCx), occurring during LCx stenting, suggestive of an ischemic etiology of sinus node dysfunction.
Collapse
Affiliation(s)
- Flavio D'Ascenzi
- Cardiologia Universitaria, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | | | | | | | | |
Collapse
|
29
|
Rose KL, Collins KA. Left atrial infarction: a case report and review of the literature. Am J Forensic Med Pathol 2009; 31:1-3. [PMID: 19949318 DOI: 10.1097/paf.0b013e3181c14f81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The majority of cardiac related deaths are due to ischemic heart disease, with the most common clinical scenario being severe coronary artery atherosclerosis resulting in left ventricular myocardial infarction. However, infarction of other cardiac chambers does occur, and often has specific clinical associations. We report a case of a 70-year-old man who suffered from left atrial infarction that resulted in a transmural rupture of his left atrium. The patient had a history of rheumatic heart disease, mitral valve stenosis, and severe atherosclerotic coronary artery disease. Four days before death, he underwent mitral valve replacement and left circumflex coronary artery bypass. Two days later, he developed atrial fibrillation. On the day of death, he had decreased mental status, questionable seizure activity, hematemesis, ventricular tachycardia, and eventually asystole. At autopsy, he had significant hemopericardium with a fibrinous pericarditis and bilateral hemothoraces (total blood volume: 1250 mL). A 0.1 to 0.2 cm left atrial transmural defect was identified. The prosthetic mitral valve was free of vegetations, and completely intact. Similarly, the left circumflex artery bypass graft was completely patent and unremarkable. Severe calcific atherosclerosis was of his native left circumflex and left main coronary arteries. Microscopic examination revealed acute myocardial infarction of the left atrium at the rupture site. The anatomy of atrial circulation as well as the pathology and consequences of atrial infarction are discussed.
Collapse
Affiliation(s)
- Kelly L Rose
- Medical University of South Carolina, Charleston, NC, USA
| | | |
Collapse
|
30
|
Abstract
Atrial fibrillation (AF) is a major arrhythmia with a high prevalence among population. AF is not uncommon in the setting of coronary artery disease, including myocardial infarction (MI) and acute coronary syndromes (ACS). Percutaneous coronary interventions (PCI) have significantly improved outcomes of patients with acute MI and acute coronary syndromes. Nevertheless, the AF was reported to occur in patients with MI and ACS undergoing PCI. New onset AF after PCI for MI and ACS, though being infrequent, was associated with worse clinical course and prognosis. The predictive value of AF has tendency to change in parallel with improvements of reperfusion strategies and comprehensive treatment. Observational studies suggest better patency of culprit vessels achieved by PCI was accompanied by improvement in signal-averaged electrocardiography indices of atrial electrophysiological properties and higher rate of restoration of sinus rhythm during primary PCI as compared with thrombolysis. The adequate management of arrhythmia is required to reduce the risk of complications.
Collapse
|
31
|
Zhang LJ, Wang YZ, Huang W, Chen P, Zhou CS, Lu GM. Anatomical investigation of the sinus node artery using dual-source computed tomography. Circ J 2008; 72:1615-20. [PMID: 18728333 DOI: 10.1253/circj.cj-08-0149] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few investigators have studied the anatomy of the sinus node artery (SNA) using noninvasive imaging modalities, so the objective of this study was to visualize the in-vivo 3-dimensional anatomical relations of the SNA using dual-source computed tomography (DSCT). METHODS AND RESULTS In the 101 patients included in this study, the visualization rate, anatomical type and diameter of the SNA, the distance between the orifice and coronary artery, and the terminal type of SNA were recorded. The visualization rate was 95.2% (96/101). Of 96 patients, 106 SNAs were detected among which 51 (48.1%, 51/106) originated from the right coronary artery, 52 (49.1%, 52/106) from the left circumflex artery, and 3 (2.7%, 3/106) from other branches. There were 3 types of SNA: right (n = 52), left (n = 45), and posterior (n = 9). The distance between the orifice of the right SNA and the right coronary sinus was 14.2+/-15.2 mm, for the left SNA it was 5.5+/-3.5 mm, and for the posterior SNA, 33.7+/-12.8 mm. The average diameter was 1.27+/-0.29 mm. The SNA approached the nodal tissue by 1 of 3 routes: retrocaval (51.5%), precaval (25.2%), or pericaval (22.3%). CONCLUSION The SNA can be visualized in vivo using DSCT, which is important for preoperative knowledge of its origin, course, termination, and anatomical type.
Collapse
Affiliation(s)
- Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, China
| | | | | | | | | | | |
Collapse
|
32
|
Sakabe M, Shiroshita-Takeshita A, Maguy A, Brundel BJ, Fujiki A, Inoue H, Nattel S. Effects of a heat shock protein inducer on the atrial fibrillation substrate caused by acute atrial ischaemia. Cardiovasc Res 2008; 78:63-70. [DOI: 10.1093/cvr/cvn019] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
33
|
Tjandrawidjaja MC, Fu Y, Kim DH, Burton JR, Lindholm L, Armstrong PW. Compromised atrial coronary anatomy is associated with atrial arrhythmias and atrioventricular block complicating acute myocardial infarction. J Electrocardiol 2005; 38:271-8. [PMID: 16003715 DOI: 10.1016/j.jelectrocard.2005.01.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The relevance of the atrial coronary anatomy in the pathogenesis of atrial arrhythmias and atrioventricular (AV) block complicating acute myocardial infarction (AMI) remains unclear. OBJECTIVES We evaluated the location of the infarct-related coronary lesion relative to the principal atrial branches (ie, sinoatrial nodal, AV nodal, left atrial circumflex) in 454 patients with ST-elevation AMI in the CAPTORS II trial. METHODS Patients underwent systematic 60-minute postfibrinolytic angiograms, and coronary anatomy was correlated with evidence of atrial arrhythmias and AV block on sequential electrocardiograms. RESULTS Patients with either sinoatrial nodal or left atrial circumflex compromise (n = 34) had a higher incidence of "early" (ie, up to 90 minutes postfibrinolysis) atrial arrhythmias vs those without (23.5% vs 7.1%; P = .004). Patients with AV nodal compromise (n = 207) had a higher incidence of "early" AV block vs those without (12.1% vs 3.6%; P = .001). CONCLUSION These findings support the etiological role of acute atrial ischemia in the development of early atrial arrhythmias and AV block complicating AMI.
Collapse
|
34
|
Asanin M, Perunicic J, Mrdovic I, Matic M, Vujisic-Tesic B, Arandjelovic A, Vasiljevic Z, Ostojic M. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. Eur J Heart Fail 2005; 7:671-6. [PMID: 15921810 DOI: 10.1016/j.ejheart.2004.07.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2004] [Revised: 05/24/2004] [Accepted: 07/05/2004] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND New-onset atrial fibrillation (AF) after acute myocardial infarction (AMI) frequently occurs in association with postinfarction complications, particularly with heart failure (HF). AIMS To evaluate whether postinfarction HF is associated with the subsequent development of AF and whether AF independently predicts poorer prognosis. METHODS AND RESULTS We examined 650 patients with AMI and compared patients with AF (n=320) to those without (n=330). AF patients were classified as either early AF (n=208)-patients who developed AF within 24 h of symptom onset or late AF (n=112)-patients who had AF thereafter. We compared outcomes between these groups, adjusting for differences in baseline characteristics and postinfarction HF. Heart failure was the most important predictor of AF. In most patients, AF occurred secondary to HF. AF patients had poorer outcomes, including higher in-hospital and 7-year mortality. After multivariate adjustment, overall, AF was not an independent predictor of in-hospital [odds ratio (OR)=0.70) and 7-year [relative risk (RR)=1.14] mortality, but late AF remained an independent predictor of 7-year (RR=2.48, 95% confidence interval, 1.26-4.87) mortality. CONCLUSIONS Heart failure mostly preceded the occurrence of new-onset atrial fibrillation after acute myocardial infarction, but only late atrial fibrillation was independently related to long-term mortality.
Collapse
Affiliation(s)
- Milika Asanin
- University Institute for Cardiovascular Disease, Clinical Center of Serbia, Emergency Center, Pasterova 2, 11000 Belgrade, Serbia&Montenegro.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Budeus M, Hennersdorf M, Dierkes S, Preik M, Heintzen MP, Kelm M, Perings C. Effects of right coronary artery PTCA on variables of P-wave signal averaged electrocardiogram. Ann Noninvasive Electrocardiol 2003; 8:150-6. [PMID: 12848797 PMCID: PMC6932014 DOI: 10.1046/j.1542-474x.2003.08210.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND P-wave signal averaged ECG has been used to detect atrial late potentials that were found in paroxysmal atrial fibrillation. Ischemia is supposed to trigger ventricular late potentials, which indicate an elevated risk for ventricular tachycardia. Preexistent ventricular late potentials measured by ventricular signal averaged ECG is supposed to be eliminated by successful PTCA. METHODS We examined the incidence of atrial late potentials in patients with a proximal stenosis of the right coronary artery and new onset of atrial fibrillation. Furthermore, we investigated the anti-ischemic effect of a successful percutaneous transluminal coronary angioplasty.(PTCA) of the right coronary artery. P-wave signal averaged ECG from 23 patients who had a PTCA of the right coronary artery (group A) were compared to age, sex, and disease-matched control subjects (group B) one day before, one day after, and one month after PTCA. RESULTS A new appearance of paroxysmal atrial fibrillation was presented in eight patients before PTCA (group A1) of group A. Patients with a stenosis of the right coronary artery had a significantly higher incidence of supraventricular extrasystoles in a 24-hour-Holter ECG (131.1 +/- 45.4 vs 17.1 +/- 18.9, P < 0.0002). The duration of the filtered P wave was longer (124.8 +/- 11.9 vs 118.5 +/- 10.1 ms, P < 0.04) and the root mean square of the last 20 ms (RMS 20) was significantly lower in group A than in group B (2.87 +/- 1.09 vs 3.97 +/- 1.12 micro V, P < 0.01). A successful PTCA caused an increase in RMS 20 (2.87 +/- 1.11 vs 4.19 +/- 1.19 microV, P < 0.02) and a decrease in filtered P-wave duration (124.8 +/- 11.9 vs 118.4 +/- 10.4 ms, P < 0.04). Preexistent atrial late potentials were found among 15 patients before PTCA. After successful PTCA only 3 out of 15 patients were affected (P < 0.0004) after one day, as well as after one month. All patients with a history of atrial fibrillation did not suffer from an arrhythmic recurrence within the following six months after successful PTCA. CONCLUSION A stenosis of the right coronary artery is associated with atrial late potentials. A successful PTCA of the right coronary artery eliminates preexistent atrial late potentials and may reduce the risk of atrial fibrillation.
Collapse
Affiliation(s)
- Marco Budeus
- Department of Cardiology, Pneumology and Angiology, Medical Clinic and Policlinic B Heinrich-Heine-University, Duesseldorf, Germany.
| | | | | | | | | | | | | |
Collapse
|
36
|
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. Atrial fibrillation and mortality among patients with acute coronary syndromes without ST-segment elevation: results from the PURSUIT trial. Am J Cardiol 2001; 88:A7, 76-9. [PMID: 11423065 DOI: 10.1016/s0002-9149(01)01593-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S M Al-Khatib
- Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Arós F, Loma-Osorio A, Alonso A, Alonso JJ, Cabadés A, Coma-Canella I, García-Castrillo L, García E, López de Sá E, Pabón P, San José JM, Vera A, Worner F. [The clinical management guidelines of the Sociedad Española de Cardiología in acute myocardial infarct]. Rev Esp Cardiol 1999; 52:919-56. [PMID: 10611807 DOI: 10.1016/s0300-8932(99)75024-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the recent years, new possibilities have emerged in the diagnosis and management of acute myocardial infarction with ST segment elevation and its complications. Moreover, a deep transformation has taken place in the health care system organization, particularly in aspects related to care of patients presenting non-traumatic chest pain, both in pre-hospital and hospital areas. All these issues warrant a consensus document in Spain dealing with the role that these important changes should play in the whole management of myocardial infarction patients. This document revises and updates all the main clinical issues of acute myocardial infarction patients from the moment they contact with the health care system outside the hospital until they return home, after staying at the coronary care unit and the general hospitalization ward. All those aspects are considered not only in the uncomplicated myocardial infarction but also in the complicated one. This review also includes a set of recommendations on structural and organisational aspects, mainly referred to the prehospital and emergency levels.
Collapse
Affiliation(s)
- F Arós
- Servicio de Cardiología, Hospital Txagorritxu, Vitoria-Gasteiz.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Galcerá Tomás J, Melgarejo Moreno A, García Alberola A, Baranco Polo M, Martínez-Lozano Aranaga F, Rodríguez Fernández S. [Incidence, clinical characteristics and prognostic significance of supraventricular tachyarrhythmias in acute myocardial infarction]. Rev Esp Cardiol 1999; 52:647-55. [PMID: 10523875 DOI: 10.1016/s0300-8932(99)74984-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The study of incidence and prognostic significance of supraventricular tachyarrhythmias in patients with acute myocardial infarction. PATIENTS AND METHODS Prospective study on 1,239 patients consecutively admitted because of a diagnosis of acute myocardial infarction. Clinical characteristics, indexes of myocardial infarction and complications were analysed. RESULTS Supraventricular tachyarrhythmias were observed in 116 (9.3%) cases: atrial fibrillation in 96 (7.7%); atrial tachycardia in 15 (1.2%); and atrial flutter in the remaining five cases (0.4%). Patients with supraventricular tachyarrhythmias were older, and presented higher heart rate, lower blood pressure, a higher number of affected leads in ECG, and higher Killip class. A higher creatine kinase peak and a lower left ventricular ejection fraction were associated with the presence of supraventricular tachyarrhythmias. Predictors of supraventricular tachyarrhythmias were: age, systolic blood pressure, number of affected leads in ECG, and congestive heart failure at admission. The following complications were found more frequently in patients with supraventricular tachyarrhythmias: bundle-branch block, complete A-V block, ventricular tachycardia, ventricular fibrillation; heart failure; stroke; and mortality, in-hospital 18.1% vs 11.1% (p < 0.05) and one-year, 38.7% vs 18.4% (p < 0.001). The logistic regression model showed that supraventricular tachyarrhythmias had no independent prognostic value on mortality. CONCLUSIONS The appearance of supraventricular tachyarrhythmias during the acute phase of myocardial infarction is a relatively frequent finding, often associated with older age and larger infarctions. Supraventricular tachyarrhythmias are accompanied by higher short and long-term mortalities, although there is no independent prognostic significance.
Collapse
Affiliation(s)
- J Galcerá Tomás
- Servicio de Medicina Intensiva, Hospital Virgen de la Arrixaca, Murcia
| | | | | | | | | | | |
Collapse
|
39
|
Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM. 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 1997; 30:406-13. [PMID: 9247512 DOI: 10.1016/s0735-1097(97)00194-0] [Citation(s) in RCA: 290] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We examined the clinical predictors and angiographic and clinical outcomes associated with atrial fibrillation in the setting of acute myocardial infarction (MI). BACKGROUND This condition has been studied primarily in prethrombolytic era small trials. METHODS We compared baseline clinical characteristics, short-term clinical and angiographic outcomes and 1-year mortality of patients enrolled in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) trial with atrial fibrillation on admission electrocardiography (n = 1,026 [2.5%]) or after enrollment (n = 3,254 [7.9%]) and those without atrial fibrillation (n = 36,611 [89.6%]). Univariable and multivariable analyses were used to assess relations between baseline factors and the development of atrial fibrillation. RESULTS Patients with any atrial fibrillation more often had three-vessel coronary artery disease and initial Thrombolysis in Myocardial Infarction (TIMI) grade < 3 flow than those without the arrhythmia. In-hospital stroke was increased in patients with atrial fibrillation (3.1% vs. 1.3%, p = 0.0001), mainly ischemic stroke (1.8% vs. 0.5%, p = 0.0001). Significant multivariable predictors of later atrial fibrillation included advanced age, higher peak creatine kinase levels, worse Killip class and increased heart rate. The unadjusted mortality rate was significantly higher at 30 days (14.3% vs. 6.2%, p = 0.0001) and at 1 year (21.5% vs. 8.6%, p < 0.0001) in patients with atrial fibrillation. The adjusted 30-day mortality rate remained significantly higher with any (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.2 to 1.4) or later (OR 1.4, 95% CI 1.3 to 1.5) atrial fibrillation but not with baseline atrial fibrillation (OR 1.1, 95% CI 0.88 to 1.3). CONCLUSIONS Atrial fibrillation in the setting of acute MI independently predicts stroke and 30-day mortality. More aggressive treatment strategies in this subgroup may be warranted and deserve further study.
Collapse
Affiliation(s)
- B S Crenshaw
- Duke Clinical Research Institute, Durham, North Carolina.
| | | | | | | | | | | |
Collapse
|
40
|
Ryan TJ, Anderson JL, Antman EM, Braniff BA, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel BJ, Russell RO, Smith EE, Weaver WD. ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol 1996; 28:1328-428. [PMID: 8890834 DOI: 10.1016/s0735-1097(96)00392-0] [Citation(s) in RCA: 640] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- T J Ryan
- American College of Cardiology, Educational Services, Bethesda, MD 20814-1699, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Masuda M, Tominaga R, Kawachi Y, Fukumura F, Morita S, Imoto Y, Toshima Y, Tomita Y, Yasui H. Postoperative cardiac rhythms with superior-septal approach and lateral approach to the mitral valve. Ann Thorac Surg 1996; 62:1118-22. [PMID: 8823099 DOI: 10.1016/0003-4975(96)00379-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The superior-septal approach provides an excellent view of the mitral valve and therefore has received considerable interest. However, the safety of this approach is controversial because it requires division of the sinus node artery in most cases. METHODS Postoperative cardiac rhythms were analyzed in 152 consecutive patients who underwent mitral valve procedures between January 1992 and February 1995 with a conventional right lateral left atriotomy (group 1, n = 69) or the superior-septal approach (group 2, n = 83). Follow-up ranged from 2 to 38 months, and the mean follow-up was 16.1 months in group 1 and 13.8 months in group 2. RESULTS The mortality rate was similar in the two groups (1.4% in group 1 and 1.2% in group 2), and the causes of death were not related to the left atriotomy. At discharge, 96% of the patients in group 1 who were in sinus rhythm preoperatively and 78% of those in group 2 remained in sinus rhythm. At the last follow-up, 88% of these patients in group 1 and 83% in group 2 remained in sinus rhythm. Among the patients in atrial fibrillation or junctional rhythm before operation, 12% in group 1 and 11% in group 2 had regained sinus rhythm at the last follow-up. There were no significant differences in these values. CONCLUSIONS Although the incidence of dysrhythmias was higher with the superior-septal approach in the early postoperative period, this approach provides an excellent operative view of the mitral valve and similar results in terms of late postoperative cardiac rhythms as the right lateral left atriotomy.
Collapse
Affiliation(s)
- M Masuda
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Serrano CV, Ramires JA, Mansur AP, Pileggi F. Importance of the time of onset of supraventricular tachyarrhythmias on prognosis of patients with acute myocardial infarction. Clin Cardiol 1995; 18:84-90. [PMID: 7720295 DOI: 10.1002/clc.4960180210] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
It is known that left ventricular (LV) function, severity of coronary artery disease, and the presence of ventricular arrhythmias are major determinants of prognosis in patients surviving an acute myocardial infarction (AMI). However, little is known about the relationship between the time of onset of supraventricular tachyarrhythmias (SVTs) and mortality. Therefore, this study was carried out in a 48-months period on 131 patients with AMI who presented with SVT during hospitalization. Of these, 53 patients (40.5%) had arrhythmia within < 12 h of MI, while 78 patients (59.5%) had arrhythmia between 12 h and 4 days. The arrhythmias studied were atrial fibrillation, atrial flutter, and paroxysmal supraventricular tachycardia. The patients were similar for age, gender, coronary risk factors, creatine kinase-MB peak, cardioversion and LV function. Angiographic features for patients with the < 12-h onset of arrhythmia were: 86.7% of the patients had uniarterial lesions, 8.9% had biarterial lesions, and 4.4% had triarterial lesions. Patients with the 12-h-4-day onset had 16.1%, 53.2%, and 30.6% (p < or = 0.05) of the respective lesions. Inferior wall myocardial infarction was more frequent among patients with the earlier onset (60.4%), while patients with the later onset presented more anterior wall infarctions (50.0%). Only 11.3% of the patients with the earlier onset presented with severe in-hospital congestive heart failure (Killip classes III-IV), versus 62.8% of the patients with the later onset (p < or = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- C V Serrano
- Heart Institute, University of São Paulo, School of Medicine, Brazil
| | | | | | | |
Collapse
|