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Relation of Recurrence of Atrial Fibrillation After Non–ST-Elevation Acute Myocardial Infarction to Left Atrial Abnormality

Published:November 12, 2007DOI:https://doi.org/10.1016/j.amjcard.2007.07.044
      Atrial fibrillation (AF) is common during the course of acute myocardial infarction and is associated with left atrial (LA) dilatation. However, the role of LA depolarization abnormality on the electrocardiogram (ECG) in the setting of LA dilatation was not studied in this context. Patients admitted with non–ST-segment elevation myocardial infarction (NSTEMI) who developed new-onset AF (International Classification of Diseases, Ninth Revision code 427.31) were prospectively identified. Baseline ECGs and echocardiograms before the admission event were reviewed. Follow-up was directed toward pertinent cardiovascular events, atrial tachyarrhythmias, and death as end points. Of 101 patients with NSTEMI who had new-onset AF, 88 had current echocardiograms and 69 had LA dilatation (78%). Total follow-up was 24 months (mean 21.4). Prolonged P-wave duration (≥110 ms) and decreased left ventricular fractional shortening were most significant in those with LA dilatation and were independently associated with AF. In those with LA dilatation, the prevalence of such abnormal atrial depolarization on ECGs was 56%. AF (43% vs 15%; p = 0.03) and heart failure (63% vs 35%; p = 0.03) occurred more often in this subset, but there was no difference in mortality. However, the overall prevalence of late cardiovascular complications in this subset was higher (71% vs 45%; p = 0.02) compared with that of immediate complications (20% vs 26%; p = 0.60). In conclusion, there is higher recurrence of AF in patients with NSTEMI who have a combination of electrocardiographic and echocardiographic LA abnormalities compared with those without.
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      References

        • Crenshaw B.S.
        • Ward S.R.
        • Granger C.B.
        • Stebbins A.L.
        • Topol E.J.
        • Califf R.M.
        Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience.
        J Am Coll Cardiol. 1997; 30: 406-413
        • Kannel W.B.
        • Abbott R.D.
        • Savage D.D.
        • McNamara P.M.
        Coronary heart disease and atrial fibrillation: the Framingham Study.
        Am Heart J. 1983; 106: 389-396
        • Vaziri S.M.
        • Larson M.G.
        • Benjamin E.J.
        • Levy D.
        Echocardiographic predictors of nonrheumatic atrial fibrillation.
        Circulation. 1994; 89: 724-730
        • Henry W.L.
        • Morganroth J.
        • Pearlman A.S.
        • Clark C.E.
        • Redwood D.R.
        • Itscoitz S.B.
        • Epstein S.E.
        Relation between echocardiographically determined left atrial size and atrial fibrillation.
        Circulation. 1976; 53: 273-279
        • Leong-Poi H.
        • Rim S.J.
        • Le D.E.
        • Fisher N.G.
        • Wei K.
        • Kaul S.
        Perfusion versus function: the ischemic cascade in demand ischemia: implications of single-vessel versus multivessel stenosis.
        Circulation. 2002; 105: 987-992
        • Ariyarajah V.
        • Kranis M.
        • Apiyasawat S.
        • Spodick D.H.
        Association of myocardial ischemia and coronary angiographic lesions with increased left atrial dimension during exercise tolerance tests among patients without known coronary heart disease.
        Am J Cardiol. 2007; 99: 1189-1192
        • Kizer J.R.
        • Bella J.N.
        • Palmieri V.
        • Liu J.E.
        • Best L.G.
        • Lee E.T.
        • Roman M.J.
        • Devereux R.B.
        Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: the Strong Heart Study (SHS).
        Am Heart J. 2006; 151: 412-418
        • Tsang T.S.
        • Abhayaratna W.P.
        • Barnes M.E.
        • Miyasaka Y.
        • Gersh B.J.
        • Bailey K.R.
        • Cha S.S.
        • Seward J.B.
        Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?.
        J Am Coll Cardiol. 2006; 47: 1018-1023
        • Goyal S.B.
        • Spodick D.H.
        Electromechanical dysfunction of the left atrium associated with interatrial block.
        Am Heart J. 2001; 142: 823-827
        • Alpert J.S.
        • Thygesen K.
        • Antman E.
        • Bassand J.P.
        Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction.
        J Am Coll Cardiol. 2000; 36: 959-969
        • The National Center for Health Statistics
        Classification of Diseases and Functioning & Disability.
        (Centers for Disease Control and Prevention, December 21, 2006.) (Accessed December 26, 2006.)
        • American College of Cardiology Foundation
        Clinical Statements/Guidelines.
        (American College of Cardiology.) (Accessed March 6, 2006.)
        • Bayes de Luna A.
        Electrocardiographic alterations due to atrial pathology.
        in: Bayes de Luna A. Clinical Electrocardiography: A Textbook. Futura, New York1998: 169-171
        • Cheitlin M.D.
        • Armstrong W.F.
        • Aurigemma G.P.
        • Beller G.A.
        • Bierman F.Z.
        • Davis J.L.
        • Douglas P.S.
        • Faxon D.P.
        • Gillam L.D.
        • Kimball T.R.
        • et al.
        • ACC; AHA; ASE
        ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article.
        J Am Soc Echocardiogr. 2003; 16: 1091-1110
        • Wang Y.C.
        • Lin L.C.
        • Lin M.S.
        • Lai L.P.
        • Hwang J.J.
        • Tseng Y.Z.
        • Tseng C.D.
        • Lin J.L.
        Identification of good responders to rhythm control of paroxysmal and persistent atrial fibrillation by transthoracic and transesophageal echocardiography.
        Cardiology. 2005; 104: 202-209
        • Moller J.E.
        • Hillis G.S.
        • Oh J.K.
        • Seward J.B.
        • Reeder G.S.
        • Wright R.S.
        • Park S.W.
        • Bailey K.R.
        • Pellikka P.A.
        Left atrial volume: a powerful predictor of survival after acute myocardial infarction.
        Circulation. 2003; 107: 2207-2212
        • Ariyarajah V.
        • Mercado K.
        • Apiyasawat S.
        • Spodick D.H.
        Correlation of left atrial size with P-wave duration in interatrial block.
        Chest. 2005; 128: 2615-2618
        • Lorbar M.
        • Levrault R.
        • Phadke J.G.
        • Spodick D.H.
        Interatrial block as a predictor of embolic stroke.
        Am J Cardiol. 2005; 95: 667-668
        • Di Tullio M.R.
        • Sacco R.L.
        • Sciacca R.R.
        • Homma S.
        Left atrial size and the risk of ischemic stroke in an ethnically mixed population.
        Stroke. 1999; 30: 2019-2024
        • Hayashida N.
        • Shojima T.
        • Yokokura Y.
        • Hori H.
        • Yoshikawa K.
        • Tomoeda H.
        • Aoyagi S.
        P-wave signal-averaged electrocardiogram for predicting atrial arrhythmia after cardiac surgery.
        Ann Thorac Surg. 2005; 79: 859-864