Atrial fibrillation (AF) commonly occurs in patient with acute
myocardial infarction (AMI). Potential triggers for AF development in this
setting includes reduced left ventricular function, advanced diastolic
dysfunction and mitral regurgitation leading to elevated left atrial pressures
and atrial stretch. Other triggering mechanisms include inflammation and atrial
ischemia. Multiple studies have shown that AF in patients with is associated
with increased mortality. However, whether AF is a risk marker or a causal
mediator of death remains controversial.
There is relative dearth of data with regard to optimal management
of AF in the setting of acute coronary syndromes. Patients with AMI who develop
AF are at increased risk of stroke. However, the issue of the most appropriate
antithrombotic regimens is complex given the need to balance stroke prevention
against recurrent coronary events or stent thrombosis and the risk of bleeding.
Presently, ‘triple therapy’ consisting of dual antiplatelet agents plus oral anticoagulants
for 3–6 months or longer has been recommended for patients at moderate–high
risk of stroke.
Credits: Mahmoud Suleiman, MD; Doron Aronson, MD