New-Onset Atrial Fibrillation in the Post-Primary PCI Setting: A Systematic Review

Open access


Background: Atrial fibrillation is a relatively common complication of acute myocardial infarction with significant impact on the short and long-term prognosis.

Methods: A systematic literature review was done through Pubmed and CENTRAL to extract data related to new-onset atrial fibrillation following primary PCI.

Results: Searching resulted in twenty-one matched studies. Extraction of data showed an incidence rate of new-onset atrial fibrillation (2.8%-58%). A negative impact was found on the outcomes of patients treated with primary PCI with increased short and long-term mortality and morbidity.

Conclusion: New-onset atrial fibrillation is an adverse prognostic marker in patients with acute myocardial infarction treated invasively. Preventive measures and anticoagulant therapy should be considered more intensively in this subset of patients.

1. Schmitt 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):1038-45.

2. Bloch Thomsen PE, Jons C, Raatikainen MJ, et al. Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study. Circulation. 2010;122(13):1258-64.

3. Sinno H, Derakhchan K, Libersan D, et al. Atrial ischemia promotes atrial fibrillation in dogs. Circulation. 2003;107(14):1930-6.

4. Worme MD, Tan MK, Armstrong DWJ, et al. Previous and New Onset Atrial Fibrillation and Associated Outcomes in Acute Coronary Syndromes (from the Global Registry of Acute Coronary Events). Am J Cardiol. 2018.

5. Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. 2011;123(15):1587-93.

6. Gonzalez-Pacheco H, Marquez MF, Arias-Mendoza A, et al. Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation. J Cardiol. 2015;66(2):148-54.

7. Braga CG, Ramos V, Martins J, et al. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis. Rev Port Cardiol. 2015;34(6):403-10.

8. Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/ EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018:ehy394-ehy.

9. Jons C, Jacobsen UG, Joergensen RM, et al. The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction: a CARISMA substudy. Heart rhythm. 2011;8(3):342-8.

10. Akdemir R, Ozhan H, Gunduz H, et al. Effect of reperfusion on P-wave duration and P-wave dispersion in acute myocar-dial infarction: primary angioplasty versus thrombolytic therapy. Ann Noninvasive Electrocardiol.. 2005;10(1):35-40.

11. Siu C-W, Jim M-H, Ho H-H, et al. Transient Atrial Fibrillation Complicating Acute Inferior Myocardial Infarction. CHEST. 2007;132(1):44-9.

12. Consuegra-Sanchez L, Melgarejo-Moreno A, Galcera-Tomas J, et al. Short- and long-term prognosis of previous and new-onset atrial fibrillation in ST-segment elevation acute myocar-dial infarction. Revista espanola de cardiologia (English ed). 2015;68(1):31-8.

13. Kinjo K, Sato H, Sato H, et al. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol. 2003;92(10):1150-4.

14. Lopes RD, Elliott LE, White HD, et al. Antithrombotic therapy and outcomes of patients with atrial fibrillation following primary percutaneous coronary intervention: results from the APEX-AMI trial. Eur Heart J. 2009;30(16):2019-28.

15. Lin CJ, Liu CF, Kung CT, Sun CK, Lin YC, Leu S, et al. The prognostic value of atrial fibrillation on 30-day clinical outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int Heart J. 2011;52(3):153-8.

16. Beukema RJ, Elvan A, Ottervanger JP, et al. Atrial fibrillation after but not before primary angioplasty for ST-segment elevation myocardial infarction of prognostic importance. Neth Heart J.. 2012;20(4):155-60.

17. Asanin M, Stankovic S, Mrdovic I, et al. B-type natriuretic peptide predicts new-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Peptides. 2012;35(1):74-7.

18. Mrdovic I, Savic L, Krljanac G, et al. Incidence, predictors, and 30-day outcomes of new-onset atrial fibrillation after primary percutaneous coronary intervention: insight into the RISK-PCI trial. Coron artery dis. 2012;23(1):1-8.

19. Rene AG, Genereux P, Ezekowitz M, et al. Impact of atrial fibrillation in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention (from the HORIZONS-AMI [Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction] trial). Am J Cardiol. 2014;113(2):236-42.

20. Gal P, Parlak E, Demirel F, et al. Prognostic significance of incident atrial fibrillation following STEMI depends on the timing of atrial fibrillation. Neth Heart J. 2015;23(9):430-5.

21. Zehir R, Tekkesin AI, Haykir N, et al. Peak troponin I level predicts new-onset atrial fibrillation in patients with myocardial infarction. Clin Invest Med.2016;39(6):E213-e9.

22. Karatas MB, Canga Y, Ipek G, et al. Association of admission serum laboratory parameters with new-onset atrial fibrillation after a primary percutaneous coronary intervention. Coron Artery dis. 2016;27(2):128-34.

23. Olsen FJ, Pedersen S, Jensen JS, Biering-Sorensen T. Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction. Medicine. 2016;95(44):e5338.

24. Garg L, Agrawal S, Agarwal M, et al. Influence of Atrial Fibrillation on Outcomes in Patients Who Underwent Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017.

25. Hwang KK, Eom SY, Lee SY, et al. Atrial Fibrillation on Admission Is Related With Higher Mortality in ST-Segment Elevation Myocardial Infarction Patients. Inte Heart J. 2017;58(4):486-94.

26. Karabag Y, Rencuzogullari I, Cagdas M, et al. Association between BNP levels and new-onset atrial fibrillation : A propensity score approach. Herz. 2017.

27. Topaz G, Flint N, Steinvil A, et al. Long term prognosis of atrial fibrillation in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention. Int J Cardiol. 2017;240:228-33.

28. Podolecki T, Lenarczyk R, Kowalczyk J, et al. Significance of Atrial Fibrillation Complicating ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017;120(4):517-21.

29. Rencuzogullari I, Cagdas M, Karakoyun S, et al. Propensity score matching analysis of the impact of Syntax score and Syntax score II on new onset atrial fibrillation development in patients with ST segment elevation myocardial infarction. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2017.

30. Rhyou HI, Park TH, Cho YR, et al. Clinical factors associated with the development of atrial fibrillation in the year following STEMI treated by primary PCI. J Cardiol. 2018;71(2):125-8.

31. Romanov A, Martinek M, Pürerfellner H, et al. Incidence of atrial fibrillation detected by continuous rhythm monitoring after acute myocardial infarction in patients with preserved left ventricular ejection fraction: results of the ARREST study. EP Europace. 2018;20(2):263-70.

32. Mazzone A, Scalese M, Paradossi U, et al. Development and validation of a risk stratification score for new-onset atrial fi-brillation in STEMI patients undergoing primary percutaneous coronary intervention. Int J Clin Practice. 2018;72(4):e13087.

33. Modin D, Olsen FJ, Pedersen S, Jensen JS, Biering-Sorensen T. Measures of left atrial function predict incident atrial fibrillation in STEMI patients treated with primary percutaneous coronary intervention. Int J Cardiol. 2018;263:1-6.

34. Asanin MR, Vasiljevic ZM, Matic MD et al. The Long-Term Risk of Stroke in Patients with Acute Myocardial Infarction Complicated with New-Onset Atrial Fibrillation. Clin Cardiol. 2009;32(8):467-70.

35. Zusman O, Amit G, Gilutz H, Zahger D. The significance of new onset atrial fibrillation complicating acute myocardial infarction. Clin Res Cardiol. 2012;101(1):17-22.

36. Bishara R, Telman G, Bahouth F, et al. Transient atrial fibrillation and risk of stroke after acute myocardial infarction. Thromb Haemost. 2011;106(5):877-84.

37. Guenancia C, Toucas C, Fauchier L, et al. High rate of recurrence at long-term follow-up after new-onset atrial fibrillation during acute myocardial infarction. Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2018.

38. Chaudhary N, Bundhun PK, Yan H. Comparing the clinical outcomes in patients with atrial fibrillation receiving dual antiplatelet therapy and patients receiving an addition of an anticoagulant after coronary stent implantation: A systematic review and meta-analysis of observational studies. Medicine. 2016;95(50):e5581.

39. Gibson CM, Mehran R, Bode C, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016;375(25):2423-34.

40. Cannon CP, Bhatt DL, Oldgren J, et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med2017;377(16):1513-24.

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 109 109 34
PDF Downloads 111 111 31