title: Compromised atrial coronary anatomy is associated with atrial arrhythmias and atrioventricular block complicating acute myocardial infarction.
abstract: 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.
authors: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2H7.
authors: Michael C
authors: MC
authors: Tjandrawidjaja
authors: Yuling
authors: Y
authors: Fu
authors: Daniel H
authors: DH
authors: Kim
authors: Jeffrey R
authors: JR
authors: Burton
authors: Lee
authors: L
authors: Lindholm
authors: Paul W
authors: PW
authors: Armstrong
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents; D011092:Polyethylene Glycols; D008666:Metalloendopeptidases; C461653:PEGylated staphylokinase SY161