The Significance of Early New Onset of Paroxysmal Atrial Fibrillation During Acute Myocardial Infarction - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Michal Axelrod Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Harel Gilutz Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Dan Greenberg Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Ygal Plakht Department of Nursing, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Lena Novack Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Background: Current practice advocates anticoagulation therapy in patients who develop atrial fibrillation (AF) during acute myocardial infarction (AMI). However, while the poorer prognosis of these patients was documented, a prognostic distinction between "early" and "late" AF onset has not been conducted. It is possible that a different AF pathogenesis of the two may be associated with a different prognosis.

Aim: To evaluate the clinical outcomes of "early" vs. "late" AF during AMI.

Methods: A retrospective, single tertiary referral center study. Consecutive patients with ST or non-ST AMI, admitted between 01/01/2002 to 30/09/2014 were included. Patients were excluded if they had a previous AF, AMI onset ≥24 hours, died within 24 form admission, had significant cardiac valve dysfunction or replacement. Clinical data were obtained from the hospital’s computerized medical records. AF was verified by reading patients’ ECG. The study population included: AMI without AF, "early AF" (AF terminated within 24 hours) and "late AF" (onset or continuing after the first 24 hours) of admission and patients were followed for a mean of 6 years Data were obtained from the Clalit’s electronic medical records. End Points included all-cause mortality and ischemic stroke.

Results are presented in the Table.

Comment: Patients with “early AF” do not have high risk for stroke compared with patients without AF, questioning the need for long-term anticoagulation. However, that group has a higher mortality rate than patients without AF in that setting.