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Published on: May 26, 2015
Conversion of infarction-associated atrial fibrillation by restoration of atrial perfusion
Robert M Blanton1, Anthony Nappi, Carey D Kimmelstiel
1Tufts Medical Center, Boston, Massachusetts 02111, USA.
Insights
This study shows restoring blood flow to the left atrium during a heart attack can convert atrial fibrillation back to normal sinus rhythm. This is the first case demonstrating this successful intervention for myocardial infarction patients.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Atrial fibrillation is a common complication of ST-segment elevation myocardial infarction (STEMI).
- Left atrial ischemia can contribute to arrhythmias during myocardial infarction.
- The management of atrial fibrillation in STEMI remains a clinical challenge.
Observation:
- A patient presented with new onset atrial fibrillation during an inferior STEMI.
- Cardiac catheterization identified a proximal left circumflex artery occlusion.
- Restoration of flow to a left atrial branch was achieved via angioplasty and stenting.
Findings:
- The successful revascularization promptly converted atrial fibrillation to atrial flutter, and subsequently to sinus rhythm.
- This intervention reversed left atrial ischemia.
- This represents the first reported case of sinus rhythm restoration by addressing left atrial ischemia in STEMI.
Implications:
- Percutaneous coronary intervention may be a strategy to manage atrial arrhythmias in STEMI.
- Reversing left atrial ischemia could be a novel therapeutic approach for arrhythmias in acute myocardial infarction.
- Further research is warranted to explore this interventional strategy in a broader patient population.
Abstract:
We report a patient who presented with new onset atrial fibrillation in the setting of inferior ST-segment elevation myocardial infarction (STEMI). Cardiac catheterization revealed proximal occlusion of the left circumflex artery. Balloon angioplasty and stenting restored flow to a large left atrial branch, with prompt conversion of the rhythm to atrial flutter, and then to sinus rhythm. To our knowledge this represents the first demonstration of restoration of sinus rhythm by reversing left atrial ischemia in the setting of STEMI.
