Schmitt Joern, Duray Gabor, Gersh Bernard J, Hohnloser Stefan H
Section of Electrophysiology, Division of Cardiology, J.W. Goethe University, Theodor-Stern-Kai 7, D 60590 Frankfurt, Germany.
Eur Heart J. 2009 May;30(9):1038-45. doi: 10.1093/eurheartj/ehn579. Epub 2008 Dec 24.
Atrial fibrillation (AF), the most commonly encountered clinical arrhythmia, often complicates acute myocardial infarction (AMI) with an incidence between 6 and 21%. Predictors of the arrhythmia in the setting of AMI include advanced age, heart failure symptoms, and depressed left ventricular function. The bulk of evidence demonstrates that AF in patients hospitalized for AMI has serious adverse prognostic implications regarding in-hospital, but also long-term mortality. This seems to apply for all patient populations studied without significant differences related to the treatment of AMI (i.e. no reperfusion therapy vs. thrombolysis vs. percutaneous coronary intervention). Mortality is particularly high in patients who have congestive heart failure and/or a reduced left ventricular ejection fraction. Finally, there are persuasive data indicating that AF complicating AMI not only increases the risk for ischaemic stroke during hospitalization but also during follow-up. This seems to apply also for transient AF which has reversed back to sinus rhythm at the time of discharge. These observations emphasize the need for prospective studies evaluating optimal therapeutic approaches for patients with AMI complicated by AF.
心房颤动（AF）是临床上最常见的心律失常，常使急性心肌梗死（AMI）复杂化，发生率在6%至21%之间。AMI患者发生这种心律失常的预测因素包括高龄、心力衰竭症状和左心室功能低下。大量证据表明，因AMI住院的患者发生AF对住院期间以及长期死亡率均有严重不良预后影响。这似乎适用于所有研究的患者群体，与AMI的治疗方法（即未进行再灌注治疗、溶栓治疗或经皮冠状动脉介入治疗）无关，没有显著差异。充血性心力衰竭和/或左心室射血分数降低的患者死亡率尤其高。最后，有确凿的数据表明，并发AF的AMI不仅增加了住院期间缺血性卒中的风险，也增加了随访期间的风险。这似乎也适用于出院时已恢复窦性心律的短暂性AF。这些观察结果强调了有必要进行前瞻性研究，以评估并发AF的AMI患者的最佳治疗方法。
