Compromised atrial coronary anatomy is associated with atrial arrhythmias and atrioventricular block complicating acute myocardial infarction.
BACKGROUND
The relevance of the atrial coronary anatomy in the pathogenesis of atrial arrhythmias and atrioventricular (AV) block complicating acute myocardial infarction (AMI) remains unclear.


OBJECTIVE
We evaluated the location of the infarct-related coronary lesion relative to the principal atrial branches (ie, sinoatrial nodal, AV nodal, left atrial circumflex) in 454 patients with ST-elevation AMI in the CAPTORS II trial.


METHODS
Patients underwent systematic 60-minute postfibrinolytic angiograms, and coronary anatomy was correlated with evidence of atrial arrhythmias and AV block on sequential electrocardiograms.


RESULTS
Patients with either sinoatrial nodal or left atrial circumflex compromise (n = 34) had a higher incidence of "early" (ie, up to 90 minutes postfibrinolysis) atrial arrhythmias vs those without (23.5% vs 7.1%; P = .004). Patients with AV nodal compromise (n = 207) had a higher incidence of "early" AV block vs those without (12.1% vs 3.6%; P = .001).


CONCLUSIONS
These findings support the etiological role of acute atrial ischemia in the development of early atrial arrhythmias and AV block complicating AMI.
Tjandrawidjaja
Michael C
MC
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2H7.
Fu
Yuling
Y
Kim
Daniel H
DH
Burton
Jeffrey R
JR
Lindholm
Lee
L
Armstrong
Paul W
PW
D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D001283:Atrioventricular Node / Q000473:pathology; D002037:Bundle-Branch Block / Q000209:etiology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006325:Heart Atria / Q000473:pathology*; D006327:Heart Block / Q000209:etiology*; D006801:Humans; D008297:Male; D008666:Metalloendopeptidases / Q000627:therapeutic use; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D017202:Myocardial Ischemia / Q000150:complications / Q000473:pathology; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012849:Sinoatrial Node / Q000473:pathology
D005343:Fibrinolytic Agents; D011092:Polyethylene Glycols; D008666:Metalloendopeptidases; C461653:PEGylated staphylokinase SY161