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CAD affecting atrial branches predictive of AF development after MI

Alasady M. Heart Rhythm. 2011;8:955-960.

Issue: September 2011

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In a population of patients with acute MI, coronary artery disease was shown to be an independent determinant of atrial fibrillation after MI.

After examining patients (n=2,460) admitted to a cardiac care unit for MI between 2004 and 2009 and excluding patients with prior AF, pericarditis, severe valvular heart disease, left ventricular hypertrophy, LV dysfunction and recent CABG, the researchers ended up with a study population of 42 AF cases and 42 MI but no AF cases (control).

Overall, AF patients had a higher likelihood of presenting with an inferior MI (P=.002), but a lower likelihood of presenting with STEMI (P=.03) and undergoing early revascularization with primary angioplasty within 6 hours (P=.004).

Researchers also found the following variables associated with AF: indexed left atrial volume (P<.001), right atrial branch disease (P<.001), sinoatrial branch disease (P<.001), LV filling pressure (P=.001), time from onset of symptoms to coronary intervention (P=.002), left atrial branch disease (P=.009) and left main stem disease (P=.02). After multivariable analysis, they determined that both right and left coronary artery arterial branch disease predicted AF after MI (P=.02).

“With the angiographic data and echocardiographic findings, our results provide novel insight into the mechanisms underlying the development of AF in patients after they experience a heart attack,” study researcher Prashanthan Sanders, MBBS, PhD, of the Royal Adelaide Hospital, Australia, said in a press release. “The findings shed new light on how coronary disease affects the atrial branches after the trauma of a heart attack regardless of measurable effects such as a patient’s gender or age.”

All of us know that AF is an unusual event in acute ischemic syndromes. Perhaps this is surprising since atrial ischemia is probably not uncommon during coronary events. In any case, AF that does occur in ACS is associated with a worse outcome and so understanding its pathogenesis is important. This paper affirms that specific patterns of CAD predict the occurrence of AF within a week of a myocardial infarction. I don't think this is particularly new information, but the size of this cohort and the precision of the coronary angiography lend value to the observation. As such, this paper adds to our knowledge of the subject and should have value to clinicians.

Peter Kowey, MD
Cardiology Today Editorial Board

Disclosures: Dr. Kowey reports no relevant financial disclosures.

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