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Mechanisms of new-onset atrial fibrillation complicating acute coronary syndrome

Pathophysiologie des neu auftretenden Vorhofflimmerns als Komplikation eines akuten Koronarsyndroms

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Abstract

Atrial fibrillation (AF) is one of the most common arrhythmia complications of acute coronary syndrome (ACS). The incidence of new-onset AF is 2.3–37 %, and it is an important predictor of a patient’s morbidity, mortality, and prolonged hospitalization. Various risk factors for the development of new-onset AF after ACS have been identified, including: old age, higher Killip class, relevant history (e.g., hypertension), and enlarged left atrium. Insights into the pathophysiological mechanisms of new-onset AF have been provided by both experimental and clinical investigations and show that new-onset AF is multifactorial, involving atrial ischemia and atrial stretch, inflammation, autonomic nervous system activity, and hormone activation. An understanding of the mechanisms underlying new-onset AF complicating ACS can provide new insight of therapeutic importance.

Zusammenfassung

Vorhofflimmern (VF) ist eine der häufigsten Arrhythmien, die als Komplikationen des akuten Koronarsyndroms („acute coronary syndrome“, ACS) auftreten. Die Inzidenz eines neu auftretenden VF liegt bei 2,3–37 %. Es stellt einen bedeutenden Prädiktor der Morbidität, Mortalität und verlängerten stationären Behandlung von Patienten dar. Verschiedene Risikofaktoren für die Entstehung eines neu auftretenden VF nach ACS sind bekannt. Dazu gehören hohes Alter, eine höhere Killip-Klasse, eine entsprechende Vorgeschichte (wie Hypertonie usw.) sowie ein vergrößerter linker Vorhof. Einblicke in die pathophysiologischen Abläufe des neu auftretenden VF sind sowohl durch experimentelle als auch durch klinische Studien gewonnen worden und zeigen, dass das neu auftretende VF „multifaktoriell“ bedingt ist – unter Beteiligung von Ischämie und Dehnung des Vorhofs, Entzündungsprozessen, Aktivität des autonomen Nervensystems und Hormonaktivierung. Das Verständnis der Vorgänge, die dem neu aufgetretenen VF als Komplikation eines ACS zugrunde liegen, kann auch zu neuen Erkenntnissen im Hinblick auf die therapeutische Bedeutung führen.

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Conflict of interest. J. Wang, Y.-M. Yang, and J. Zhu state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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  1. Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

    J. Wang, Y.-M. Yang & J. Zhu

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Wang, J., Yang, YM. & Zhu, J. Mechanisms of new-onset atrial fibrillation complicating acute coronary syndrome. Herz 40 (Suppl 1), 18–26 (2015). https://doi.org/10.1007/s00059-014-4149-3

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