Arq. Bras. Cardiol. 2019; 113(5): 958-959
Clinical Management of Patients with First-Episode Atrial Fibrillation Detected in the Acute Phase of Myocardial Infarction
Mauricio Scanavacca
, Tan Chen Wu
This Short Editorial is referred by the Research article "New-Onset Atrial Fibrillation in St-Segment Elevation Myocardial Infarction: Predictors and Impact on Therapy And Mortality".
Atrial fibrillation (AF) episodes have been traditionally observed in up to 20% of the patients who suffer an acute myocardial infarction (AMI); 5-10% of them, as a “first episode”, during hospital admission. The etiology of AF, in this phase of AMI, includes several factors, such as elevated atrial pressure resulting from acute ventricular dysfunction, associated atrial ischemia (more common in inferior wall AMI), secondary inflammatory reaction, changes in autonomic nervous system behavior and in the neurohumoral pattern related to the pathophysiology of AMI, especially in those with ventricular dysfunction.–
A recent study published in the Arquivos Brasileiros de Cardiologia by Congo et al. suggest that, in the last years, the incidence of AF in the acute phase of AMI may be decreasing, due to the greater access of patients to early reperfusion and to better clinical treatment, associated with the more frequent use of angiotensin converting enzyme inhibitors (ACE inhibitors), beta blockers, statins and antiplatelet therapy. In addition, the study corroborates previous observations that new onset AF is associated to poorer clinical evolution and raises awareness of the clinical management of these patients, in particular in relation to the non-use of oral anticoagulants at hospital discharge.
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