A. Yagensky, M. Pavelko, I. Sichkaruk

Lutsk City Clinical Hospital

Introduction. Atrial fibrillation (AF) occurs in 8.0-22.0% of patients with acute myocardial infarction (MI). It is associated with a significant increase in both hospital mortality and mortality over a 5-year observation period. AF can be the result of a number of pathological processes – hemodynamic disorders, ischemia or AF (especially in patients with early AF), right ventricular infarction, pericarditis, excessive release of catecholamines, chronic lung diseases, acute hypoxia, use of sympathomimetics, hypokalemia, etc.

Aim. To find out the incidence of AF, its association with structural changes in the heart, heart failure, and other factors in patients in the remote period after MI.

Materials and methods. To assess the AF prevalence and its association with the changes in heart structure and heart failure 169 patients with previous MI (135 men, 34 women; mean age 57,3 ± 11,4 years) were included into the study. Mean time after the first MI was 4,96 ± 4,64 years. AF was found in 33 patients (19,5 %): in 23 patients (13,6 %) AF was considered as permanent, in 10 (5,9 %) as paroxysmal.

Results. As result of a multiple logistic regression analysis, only the age and the volume of a right atrium were found as the independent predictors of AF. Every 10 years of life of the patients the probability of the permanent AF risk increases more then two-fold (110,0 %), and increase of the volume of right atrium for every 50,0 ml – three-fold (200,0 %). Prevalence of permanent AF increases with the growth of heart failure functional class whereas paroxysmal AF does not depend on heart failure severity.

It was found that AF occurs in 19.5% of the patients in the remote period after MI, paroxysmal form – in 5.9%, permanent – in 13.6%. The frequency of continuous permanent AF in patients after MI increases with an increase of the severity of heart failure. At the same time, the functional class of heart failure was not an independent predictor of AF. Patients with permanent AF were older, had larger atrium, more severe heart failure, and greater degree of regurgitation through the mitral and tricuspid valves. Patients with paroxysmal form of arrhythmia occupied an intermediate position among the patients with a permanent form and without arrhythmia for most of the indices. Independent predictors of AF were only the age and volume of the right atrium.

Conclusions. When assessing the risk of AF special attention should be paid to the parameters like the size of the right atrium and the degree of regurgitation through the tricuspid valve.

References

1. Diagnosis and Treatment of Atrial Fibrillation. Recommendations of the Working Group on Cardiac Arrhythmia of the Association of Cardiologists of Ukraine. Kyiv, 2011. 159 p. (Ukrainian)
2. Jabre P, Jouven X, Adnet F, Thabut G, Bielinski SJ, Weston SA et al. Atrial fibrillation and death after myocardial infarction. A Community Study. Circulation. 2011;123(19):2094-2100. https://doi.org/10.1161/CIRCULATIONAHA.110.990192
3. Shmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30(9):1038-1045. https://doi.org/10.1093/eurheartj/ehn579
4. Chamberlain AM, Bielinski SJ, Weston SA, Klaskala W, Mills RM, Gersh BJ et al. Atrial fibrillation in myocardial infarction patients. Impact on health care utilization. Am Heart J. 2013;166(4):753-759. https://doi.org/10.1016/j.ahj.2013.07.013
5. Alasady M, Abhayaratna W, Lim H, Leong D, Roberts-Thomson K, Chew D et al. Atrial ischemia is an important determinant of atrial fibrillation after myocardial infarction. Heart Lung Circulation. 2010;19(2 Suppl):S98.
6. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am. J Cardiol. 1986;57(6):450-458. https://doi.org/10.1016/0002-9149(86)90771-X
7. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719-2747.
8. Minicucci MF, Azevedo PS, Polegato BF, Paiva SA, Zornoff LA. Heart Failure After Myocardial Infarction: Clinical Implications and Treatment. Clin Cardiol. 2011;34(7):410-414. https://doi.org/10.1002/clc.20922
9. Pizzetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, Maggioni AP et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart. 2001;86(5):527-532. https://doi.org/10.1136/heart.86.5.527
10. Parashar S, Kella D, Reid KJ, Spertus JA, Tang F, Langberg J et al. New-onset atrial fibrillation after acute myocardial infarction and its relation to admission biomarkers (from the TRI-UMPH Registry). Am J Cardiol. 2013;112(9):1390-1395. https://doi.org/10.1016/j.amjcard.2013.07.006
11. Martínez-Sellés M, Datino T, Figueiras-Graillet LM, Bueno H, Fernández-Aviles F. New-onset atrial fibrillation and prognosis in nonagenarians after acute myocardial infarction. Neth Heart J. 2013;2(11):499-503. https://doi.org/10.1007/s12471-013-0439-2