Frequency of New Onset Atrial Fibrillation In Patients Presenting With Acute Coronary Syndrome

Background: Atrial fibrillation (AF) is a frequent complication of acute coronary syndromes (ACS) and is associated with an increased risk of in-hospital and long-term mortality. New onset atrial fibrillation (AF) in conditions of the acute coronary syndrome (ACS). Despite advances in the diagnosis and management of acute coronary syndrome (ACS), atrial fibrillation (AF) remains a commonly encountered complication leading to adverse short-and long-term outcomes across the whole spectrum of ACS. Objective: To assess the frequency of new-onset atrial fibrillation in patients presenting with the acute coronary syndrome in our population. Study Design: Cross-sectional study Study


Introduction
Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in non-ST-segment elevation myocardial infarction (NSTEMI) or in unstable angina.It is almost always associated with rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery.[1] Atrial fibrillation (AF) confers a substantial risk of mortality and morbidity from stroke and thromboembolism, and this common cardiac arrhythmia represents a major healthcare burden.The rationale of this study is to assess the frequency of new-onset AF in patients presenting with ACS in our population.Literature has shown that new-onset AF is a common complication of ACS.
Controversial data have been retrieved through literature.Moreover, there is no local evidence available which shows that to what extent, the new onset of AF occurs after ACS.So, there is a need to perform a study on the local population to confirm the evidence.This study will help us to get local evidence and in the future, we can plan better preventive and management protocols to reduce complications of ACS and new-onset AF and achieve a better prognosis for the patient.
Objective: To assess the frequency of new-onset atrial fibrillation in patients presenting with the acute coronary syndrome in our population.

Subjects and Method:
A Cross-sectional study was conducted at the Department of Cardiology, Jinnah Hospital, Lahore from April 2018 -March 2019.A sample size of 150 patients is calculated with a 95% confidence level, 5% margin of error, and taking an expected percentage of new-onset AF i.e. 11.94% in patients with ACS7 through a non-probability, consecutive sampling.ACS was defined chest pain, with ST-elevation on ECG and troponins > 0.01 ng/ ml in STEMI, without ST-elevation and troponins > 0.01 ng/ml in NSTEMI, and without ST elevation and troponins < 0.01 ng/ml in Unstable Angina.
New onset atrial fibrillation was labeled if there will be an abnormal heartbeat and ECG changes with the absence of P waves and irregular R-R.Patients with a non-previous history of AF will be labeled as newonset AF.Patients aged 35-70years, of either gender, presenting with ACS were included and Patients with prior AF or taking medicine for AF undergoing CABG with valvular or congenital heart surgery and with thyroid disease were excluded from the study.Then patients underwent ECG by a senior cardiologist and if there was an abnormal heartbeat and ECG changes, then new-onset AF was labeled.Data was entered and analyzed through IBM SPSS21.Mean and SD was calculated for quantitative variables like age, BMI, and duration of ACS.Frequency and percentage will be done for categorical variables like gender, history of diabetes, and new onset AF.Data will be stratified for age, gender, BMI, duration of ACS, and history of diabetes (BCR > 200mg/ dl).Post-stratification, the chi-square test will be applied with P ≤ 0.05 taken as significant.

Results
The mean age was 55. 15  The present study has several important contributions to clinical practice and the treatment of patients with ACS with the foremost being that the clinical significance of transient AF episodes in ACS should not be neglected.

Conclusion
The conclusion of the study frequency of development of new-onset AF was very low in our study population.Age, gender, Diabetes mellitus, BMI, and duration of ACS were not significantly associated with new-onset atrial fibrillation in patients with the acute coronary syndrome.Further experimental and clinical studies are needed to improve the current understanding and management of new-onset AF in ACS patients.

Contributions
UMB conceived the idea, designed the study and analyzed the data.JZ and UM did data collection.MKI and FMZ did the manuscript writing.
MAQ did review and final approval of manuscript.All the authors contributed significantly to the research that resulted in the submitted manuscript.

[ 2 ]
Despite advances in the diagnosis and management of ACS, AF remains a commonly encountered complication leading to adverse short-and long-term outcomes across the whole spectrum of ACS.[3] Initiation of AF are typically due to focal automaticity within the pulmonary vein musculature.Triggers include ganglionic plexi that reside near the antral portion of the pulmonary vein-left atrial junction.[4] The incidence of new-onset AF is 10.7 %, and it is an important predictor of a patient's mortality.5One study showed that the frequency of newonset AF was 2.3-23 % in patients presenting with ACS.[6] Another study reported the frequency of new-onset AF was 11.94 % in patients presenting with ACS.[7] While one study reported the frequency of AF was 13.8 % in patients presenting with ACS, out of which 73.3 % had new-onset AF while 26.8 % had previous AF.[8] A recent study Citation: Butt UM, Zaffar J, Masood U, Iqbal MK, Zia FM, et al. (2022) Frequency of New Onset Atrial Fibrillation In Patients Presenting With Acute Coronary Syndrome.Journal of Heart and Cardiovascular Imaging 01(01): https://doi.org/10.38207/JHCI/2022/010101by Santos H found new-onset AF incidence in ACS around 4.1 %. [9]

Journal of Heart and Cardiovascular Imaging
[26]tion: Butt UM, Zaffar J, Masood U, Iqbal MK, Zia FM, et al. (2022) Frequency of New Onset Atrial Fibrillation In Patients Presenting With Acute Coronary Syndrome.Journal of Heart and Cardiovascular Imaging 01(01): https://doi.org/10.38207/JHCI/2022/010101Tableno2:stratification of atrial fibrillation with age, gender, BMI and Diabetes Mellitus and duration of ACS complications of the acute coronary syndrome (ACS).[10]Theincidence of new-onset AF is 2.3-37 %, and it is an important predictor of a patient's morbidity, mortality, and prolonged hospitalization.[11]Variousriskfactorsfor the development of new-onset AF after ACS have been identified, including old age, female gender, hypertension, diabetes mellitus, chronic kidney disease, and peripheral arterial disease.[12]In the current study mean age, BMI, and duration of the acute coronary increase in hospitalizations due to AF between 1993 and 2013.[17]Inthisstudyincidence of new-onset atrial fibrillation was in 20(13.3%) of the total patients presenting with the acute coronary syndrome.In this study, we found that diabetes mellitus is one of the risk factors for atrial fibrillation.Out of 150 patients, 57(38 %) had DM. which frequency of new-onset AF was 12.5 % in patients presenting with acute myocardial infarction (AMI),[26]while one study reported the frequency of new-onset AF was 14.2 % in patients presenting with AMI.[