Features of Clinical Course of Acute Period of Myocardial Infarction in Patients with Atrial Fibrillation and Their Influence on Cardiac Hemodynamics and Prognosis

Abstract

Introduction. Atrial fibrillation (AF) is a major public health problem and causes significant financial costs for the health system. Aim. To establish the peculiarities of the clinical course of acute myocardial infarction period in patients with atrial fibrillation and its effect on cardiac hemodynamics and prognosis. Materials and methods. 116 patients with acute myocardial infarction (MI) and non-valvular form of atrial fibrillation, with an average age of 65.82 ± 10.51 years, were examined. Diagnosis was verified according to ESC guidelines (2016). Patients were divided into two groups: the experimental group consisted of patients with MI in combination with AF (66 patients) and the control group – patients with MI without AF (50 patients). Parameters of central and peripheral hemodynamics were determined using doppler echocardiography on the device Philips HD11HE, sensor number S 4-2. Results. The analysis of the data showed that AF in patients with acute MI causes remodeling of the chambers of the heart with the development of aortic dilatation (3.73 ± 0.41 cm, p < 0.01), left atrium (4.49 ± 0.42 cm, p < 0.001), right (2.46 ± 0.55 cm, p < 0.05) and left ventricles (5.4 ± 0.63 cm, p < 0.01) with the decrease of the contractile capacity of the latter (ejection fraction – 40.48 ± 7.57 %, p < 0.01). In turn, it leads to complications of MI, namely, among the surveyed experimental group, cardiogenic shock (21.2 %, p = 0.017) was significantly more common than in patients without arrhythmias (2.0 %) and conduction impairment: acute complete blockade of left bundle branch block (18.2 % vs. 2.0 %, p = 0.014) and acute complete atrioventricular blockade (15.2 % vs. 2.0 %, p = 0.014). It was found that lethality at the inpatient stage of treatment was the highest among those surveyed, in which myocardial ischaemia arose in association with AF and amounted to 7.6 % (p = 0.048) of the observed. Conclusions. Thus, the association of atrial fibrillation with myocardial infarction is marked by the heavier course of the acute period with more frequent development of complications, instability of hemodynamics, conduction disturbances, and pathological post-infarctionventricular remodeling of the heart, which leads to higher mortality and serves as a marker for an unfavorable prognosis.

Keywords

• atrial fibrillation
• clinical course
• myocardial infarction