title: New insights into symptomatic or silent atrial fibrillation complicating acute myocardial infarction.
abstract: Atrial fibrillation (AF) is the most frequent heart rhythm disorder in the general population and contributes not only to a major deterioration in quality of life but also to an increase in cardiovascular morbimortality. The onset of AF in the acute phase of myocardial infarction (MI) is a major event that can jeopardize the prognosis of patients in the short-, medium- and long-term, and is a powerful predictor of a poor prognosis after MI. The suspected mechanism underlying the excess mortality is the drop in coronary flow linked to the acceleration and arrhythmic nature of the left ventricular contractions, which reduce the left ventricular ejection fraction. The principal causes of AF-associated death after MI are linked to heart failure. Moreover, the excess risk of death in these heart failure patients has also been associated with the onset of sudden death. Whatever its form, AF has a major negative effect on patient prognosis. In recent studies, symptomatic AF was associated with inhospital mortality of 17.8%, to which can be added mortality at 1year of 18.8%. Surprisingly, silent AF also has a negative effect on the prognosis, as it is associated with an inhospital mortality rate of 10.4%, which remains high at 5.7% at 1year. Moreover, both forms of AF are independent predictors of mortality beyond traditional risk factors. The frequency and seriousness of silent AF in the short- and long-term, which were until recently rarely studied, raises the question of systematically screening for it in the acute phase of MI. Consequently, the use of continuous ECG monitoring could be a simple, effective and inexpensive solution to improve screening for AF, even though studies are still necessary to validate this strategy. Finally, complementary studies also effect of oxidative stress and endothelial dysfunction, which seem to play a major role in triggering this rhythm disorder.
authors.affiliation: Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Stamboul
authors.affiliation: Cardiology Department, Trousseau University Hospital and François-Rabelais University, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Gudjoncik
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Buffet
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Garnier
authors.affiliation: Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Lorgis
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Beer
authors.affiliation: Cardiology Department, University Hospital, Dijon, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Touzery
authors.affiliation: Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France. Electronic address: yves.cottin@chu-dijon.fr.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
mesh_terms: D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D003326:Coronary Circulation; D004730:Endothelium, Vascular / Q000503:physiopathology; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D018384:Oxidative Stress; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: Acute myocardial infarction; Asymmetric dimethylarginine; Asymétrique diméthylarginine; Continuous ECG monitoring; Fibrillation atriale silencieuse; Infarctus du myocarde; Prognosis; Pronostic; Silent atrial fibrillation; Surveillance ECG en continue