THE RÔLE OF CORONARY ARTERY DISEASE IN THE ETIOLOGY OF AURICULAR FIBRILLATION

Abstract

From the tabulated data of 500 autopsied cases the following conclusions were drawn: In the absence of congestive heart failure or acute coronary occlusion, coronary artery disease is not a cause of auricular fibrillation. Congestive heart failure involving the left side of the heart, regardless of the underlying pathological lesion, tends to favor the development of auricular fibrillation. It is suggested that stretching of the left auricle might be an important factor in this process. Coronary artery disease, although not a direct cause of auricular fibrillation, nevertheless may be concerned indirectly in the genesis of the arrhythmia by first inducing congestive failure. This mechanism is offered as a probable explanation for the frequent appearance of transient auricular fibrillation following an attack of acute coronary thrombosis, although this arrhythmia occurs very rarely in angina pectoris of coronary origin prior to the onset of congestive failure. In a case already in congestive failure, the subsequent appearance of auricular fibrillation affords no additional information which might serve as an aid in determining the presence or the absence of coronary artery disease. An analysis of the records of 100 cases of angina pectoris under active treatment confirms the observation already noted by many authors that auricular fibrillation is rare in angina pectoris of coronary origin, except in the presence of congestive failure.