Official reprint from UpToDate®
www.uptodate.com ©2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Supraventricular arrhythmias after myocardial infarction

David Spragg, MD, FHRS
Kapil Kumar, MD
Section Editors
Brian Olshansky, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
James Hoekstra, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Supraventricular arrhythmias, other than atrial fibrillation or flutter, are relatively uncommon in the periinfarction period. Their occurrence often indicates myocardial dysfunction and they may, by themselves, cause congestive heart failure or exacerbate ongoing myocardial ischemia.

The incidence, mechanism, and treatment of supraventricular arrhythmias (particularly sinus bradycardia, sinus tachycardia, and atrial fibrillation) occurring after myocardial infarction (MI) will be reviewed here. The following related topics are discussed separately: conduction disturbances after MI, pathophysiology of ventricular arrhythmias during MI, the clinical characteristics and treatment of ventricular arrhythmias with MI, and risk stratification of patients after MI.


Sinus bradycardia, defined as less than 50 to 60 beats/min, occurs in 15 to 25 percent of patients after acute MI [1-3]. It has the following clinical characteristics [1,2,4]:

It is frequently seen with inferior wall infarctions, since the right coronary artery supplies the sinoatrial node (SA) in approximately 60 percent of people.

It is most often transient, particularly for sinus bradycardia occurring within the first six hours; such arrhythmias typically resolve within 24 hours.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Dec 2017. | This topic last updated: Nov 17, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2018 UpToDate, Inc.
  1. Marks R, Beard RJ, Clark ML, et al. Gastrointestinal observations in rosacea. Lancet 1967; 1:739.
  2. Adgey AA, Geddes JS, Mulholland HC, et al. Incidence, significance, and management of early bradyarrhythmia complicating acute myocardial infarction. Lancet 1968; 2:1097.
  3. Rotman M, Wagner GS, Wallace AG. Bradyarrhythmias in acute myocardial infarction. Circulation 1972; 45:703.
  4. Zimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med 2003; 348:933.
  5. Goldberg S, Greenspon AJ, Urban PL, et al. Reperfusion arrhythmia: a marker of restoration of antegrade flow during intracoronary thrombolysis for acute myocardial infarction. Am Heart J 1983; 105:26.
  6. Zipes DP. The clinical significance of bradycardic rhythms in acute myocardial infarction. Am J Cardiol 1969; 24:814.
  7. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. www.acc.org/qualityandscience/clinical/statements.htm (Accessed on August 24, 2006).
  8. Topol EJ, Goldschlager N, Ports TA, et al. Hemodynamic benefit of atrial pacing in right ventricular myocardial infarction. Ann Intern Med 1982; 96:594.
  9. Goldberg RJ, Seeley D, Becker RC, et al. Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective. Am Heart J 1990; 119:996.
  10. Crimm A, Severance HW Jr, Coffey K, et al. Prognostic significance of isolated sinus tachycardia during first three days of acute myocardial infarction. Am J Med 1984; 76:983.
  11. Becker RC, Burns M, Gore JM, et al. Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes: a nationwide perspective of current clinical practice. The National Registry of Myocardial Infarction (NRMI-2) Participants. Am Heart J 1998; 135:786.
  12. JAMES TN. Myocardial infarction and atrial arrhythmias. Circulation 1961; 24:761.
  13. Wong CK, White HD, Wilcox RG, et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J 2000; 140:878.
  14. Crenshaw BS, Ward SR, Granger CB, et al. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol 1997; 30:406.
  15. Pizzetti F, Turazza FM, Franzosi MG, et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart 2001; 86:527.
  16. Eldar M, Canetti M, Rotstein Z, et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. Circulation 1998; 97:965.
  17. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J 2009; 30:1038.
  18. Jons C, Jacobsen UG, Joergensen RM, et al. The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction: a CARISMA substudy. Heart Rhythm 2011; 8:342.
  19. Pedersen OD, Bagger H, Køber L, Torp-Pedersen C. The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evalution. Eur Heart J 1999; 20:748.
  20. Behar S, Zahavi Z, Goldbourt U, Reicher-Reiss H. Long-term prognosis of patients with paroxysmal atrial fibrillation complicating acute myocardial infarction. SPRINT Study Group. Eur Heart J 1992; 13:45.
  21. Hod H, Lew AS, Keltai M, et al. Early atrial fibrillation during evolving myocardial infarction: a consequence of impaired left atrial perfusion. Circulation 1987; 75:146.
  22. Sakata K, Kurihara H, Iwamori K, et al. Clinical and prognostic significance of atrial fibrillation in acute myocardial infarction. Am J Cardiol 1997; 80:1522.
  23. Celik S, Erdöl C, Baykan M, et al. Relation between paroxysmal atrial fibrillation and left ventricular diastolic function in patients with acute myocardial infarction. Am J Cardiol 2001; 88:160.
  24. Nagahama Y, Sugiura T, Takehana K, et al. The role of infarction-associated pericarditis on the occurrence of atrial fibrillation. Eur Heart J 1998; 19:287.
  25. Kramer RJ, Zeldis SM, Hamby RI. Atrial fibrillation--a marker for abnormal left ventricular function in coronary heart disease. Br Heart J 1982; 47:606.
  26. Danchin N, Fauchier L, Marijon E, et al. Impact of early statin therapy on development of atrial fibrillation at the acute stage of myocardial infarction: data from the FAST-MI register. Heart 2010; 96:1809.
  27. Køber L, Bloch Thomsen PE, Møller M, et al. Effect of dofetilide in patients with recent myocardial infarction and left-ventricular dysfunction: a randomised trial. Lancet 2000; 356:2052.
  28. Cameron A, Schwartz MJ, Kronmal RA, Kosinski AS. Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry). Am J Cardiol 1988; 61:714.
  29. Ganz LI, Friedman PL. Supraventricular tachycardia. N Engl J Med 1995; 332:162.
  30. Konecke LL, Knoebel SB. Nonparoxysmal junctional tachycardia complicating acute myocardial infarction. Circulation 1972; 45:367.
  31. Knoebel SB, Rasmussen S, Lovelace DE, Anderson GJ. Nonparoxysmal junctional tachycardia in acute myocardial infarction: computer-assisted detection. Am J Cardiol 1975; 35:825.
  32. Berisso MZ, Ferroni A, Molini D, Vecchio C. [Supraventricular tachyarrhythmias during acute myocardial infarction: short- and mid-term clinical significance, therapy and prevention of relapse]. G Ital Cardiol 1991; 21:49.
  33. Bigger JT Jr. Digitalis toxicity. J Clin Pharmacol 1985; 25:514.
  34. Kastor JA, Yurchak PM. Recognition of digitalis intoxication in the presence of atrial fibrillation. Ann Intern Med 1967; 67:1045.