Acute coronary syndromes and atrial fibrillation

Acute coronary syndromes and atrial fibrillationAtrial fibrillation is the most common sustained cardiac arrhythmia and affects 1.5%e2% of the general population.More than six million Europeans suffer from atrial fibrillation, and the incidence of atrial fibrillation is estimated to double over the next 50 years.The incidence of atrial fibrillation increases with age, from <0.5% at 40 to 50 years old, up to 5% to 15% at 80 years old.Men suffer more often than women from atrial fibrillation.It is estimated that more than 8 million patients over 80 years old will be affected by atrial fibrillation in 2050.Atrial fibrillation is associated with an increased risk of stroke, heart failure and death, as well as a deterioration in the quality of life. 1 Atrial fibrillation, permanent or paroxysmal, is common in patients with acute coronary syndrome.The associated mechanisms for the development of atrial fibrillation in these patients includes ischemia and reduced atrial blood flow, increased left ventricle end-diastolic pressure and left atrial pressure, diastolic dysfunction and disorders of the autonomic nervous system.Recently, inflammation and neurohormonal activation mechanisms appear to be associated with the development of atrial fibrillation in patients with acute myocardial infarction.The incidence of atrial fibrillation in acute coronary syndromes ranges from 2% to 23%.Recently, a downward trend in the incidence of atrial fibrillation in patients with acute coronary syndromes has been observed and this could be explained by the widespread use of thrombolytic therapy and percutaneous coronary interventions (PCI).The primary clinical prognostic markers of risk for atrial fibrillation in patients with acute coronary syndromes are advanced age, tachycardia on admission and advanced heart failure. 2 Atrial fibrillation increases the risk of worsening ischemia, heart failure and thromboembolic complications.Patients with acute coronary syndromes who developed atrial fibrillation, have increased in-hospital and long-term mortality.In a large meta-analysis that included 278,854 patients with myocardial infarction by 43 trials, atrial fibrillation was associated with a 40% increase in the risk of death compared to patients with sinus rhythms.Moreover,