Predictive Factors for New-Onset Atrial Fibrillation in Patients with ST-Elevation Myocardial Infarction (STEMI) undergoing Primary Percutaneous Coronary Intervention

Abstract

Atrial fibrillation (AF) is the predominant cardiac arrhythmia seen in humans, regardless of the presence or absence of underlying structural heart disease. The increasing incidence of AF may be attributed mostly to the progressive aging of the population. AF is shown to be present in around 35% of those diagnosed with stable coronary artery disease (CAD), making it the second most common comorbidity in patients with AF. Episodes AF have the potential to trigger the onset of an acute coronary syndrome (ACS) due to the heightened myocardial oxygen demand associated with increased tachycardia. Cardiac damage and atrial remodeling caused by ACS have been shown to directly cause AF. Percutaneous coronary intervention (PCI) is often used to treat individuals with AF who also have CAD due to the same risk factors between the two conditions. The development of AF in this setting may be effected by various factors, including elevated atrial pressure, ischemia, high left ventricular end-diastolic pressure, reduced atrial perfusion, glycolytic anaerobic pathways, inflammation, abnormalities in autonomic regulation, neurohumoral factors and other relevant factors. These factors have been observed to contribute to the development of AF in other critical illnesses as well. It was hypothesized that the prognostic and prevalence significance of AF after AMI would shift as a result of improvements in reperfusion methods and modern treatment with statins, antiplatelet medication and ACE inhibitors.